Healthcare utilization and costs in adults with type 2 diabetes treated with first or second-generation basal insulins in England.

Abstract

Introduction: The prevalence of people with type 2 diabetes (T2D) on basal insulin (BI) is rising to improve glucose control and minimize complications. However, limited evidence exists regarding the economic impact of second-generation BI analogs compared with first-generation BI in the United Kingdom.

Research design and methods: In this comparative retrospective, observational study, adults with T2D who initiated treatment with a first-generation BI (eg, glargine 100 U/mL, detemir) and switched to another first-generation or a second-generation BI (glargine 300 U/mL (Gla-300) or degludec) (index date) between 1 July 2014 and 31 March 2021 were analyzed using the Clinical Practice Research Datalink (CPRD) Aurum linked to Hospital Episode Statistics. Subjects were followed from the index date until the end of observation period, deregistration in CPRD or death. Propensity score weighting balanced baseline characteristics and healthcare resource utilization (HCRU) and costs were compared using standardized differences and zero-inflated regression models.

Results: A total of 13 975 people with T2D (mean (SD) age: 62.45 (13.59) years) treated with a first-generation BI who switched to another first-generation BI (n=5654), Gla-300 (n=4737) or degludec (n=3584) were included. Mean (SD) follow-up time was 4.98 (4.27), 1.96 (1.62) and 2.05 (1.92) years for the first-generation BI, Gla-300 and degludec groups, respectively. Overall, people who switched to Gla-300 had significantly lower HCRU. Fewer people in the Gla-300 group received hypoglycemia-related healthcare compared with those in the first-generation BI group (9.1% vs 16.4%, incident rate ratio (IRR)=0.41, p<0.001) and the degludec group (9.2% vs 11.7%, IRR=0.51, p<0.001). During follow-up, diabetes-related and diabetic ketoacidosis-related total direct costs were lower for the Gla-300 group compared with the first-generation BI group by 17% and the degludec group by 60%, respectively.

Conclusions: These findings suggest that Gla-300 may offer clinical and economic benefits by reducing hypoglycemia incidents and lowering healthcare costs compared with first-generation BI.