ANÁLISIS COSTE-UTILIDAD DEL TRATAMIENTO DE LA DIABETES MELLITUS CON INSULINA GLARGINA O INSULINA NPH EN ESPAÑA

Objectives. To compare the efficacy of two treatments of the diabetes mellitus: insulin glargine, an analogue of long-acting insulin (Lantus®), and intermediate acting isophanic insulin (NPH insulin). Method. Modelized retrospective cost-utility analysis, from the pers- pective of the Spanish Health System (considering the direct health costs). It was simulated the evolution during 9 years of the patients with type 1 diabetes (DM1) included in the DCCT study, as well as the evolution during 10 years of the patients with type 2 diabetes (DM2) included in the prospective UKPDS study. The data were estimated from the DCCT and UKPDS studies, from a database on Spanish health costs. In DM1, the utilities (quality-adjusted life years, QALY) were obtained from the CODE-2 study, which measured the quality of life in different diabetic complications by means of the EQ-5D instrument. Results. In the basic case, with Lantus there would be an average profit per patient, with or without discounts respectively, from 0.754 to 0.799 QALY and from 0.238 to 0.254 QALY as compared to NPH, in DM1 and DM2 respectively. The cost of each additional QALY obtained with Lan- tus would be of from 2,340 to 2,755 euros and from 9,243 to 10,969 euros (€ 2002) in DM1 and DM2. In DM1, if the effectiveness differen- ces were not taken into account, the cost of the treatment during 9 years with insulin NPH would be lower than that with Lantus (from 1,764 to 2,202 euros less). Conclusions. According to this model, Lantus is more efficient (with a cost per QALY gained lower than the one considered as acceptable for the adoption of a new treatment) produces less hypoglycaemic events (specia- lly night and serious events, the most clinically significant) and proves a better control of the A1C levels than the insulin NPH does, which would mean less diabetic complications in the long term. In most of the assump- tions it's useful cost, providing more QALY and with less costs due to com- plications than insulin NPH.