Impacto económico y sanitario de las hipoglucemias nocturnas asociadas al tratamiento de la diabetes mellitus tipo 2 con insulina glargina o insulina NPH

Abstract

Objective

To estimate the health and economic impact in Spain of nocturnal hypoglycemia linked to the treatment of type 2 diabetes with insulin glargine (IG) or NPH insulin, both administered before bedtime.

Methods

The current cost of severe and symptomatic nocturnal hypoglycemia and the savings for the National Health Service (NHS) as a result of the reduction in the rate of occurrence of nocturnal hypoglycemia was calculated in the hypothetical case that the treatment with NPH was partially replace by IG. The use of health resources in clinical practice and the annual cost of hypoglycemic events were estimated by an expert panel of primary care and hospital clinicians. The reduction in the rate of hypoglycemic events with IG versus NPH was obtained from a published meta-analysis.

Results

The annual cost of hypoglycemia was estimated at 1,121.98 € (518.90-1,990.19 €) in the case of severe hypoglycemia, 473.85 € (243.22-733.82 €) in case of symptomatic hypoglycemia with plasma glucose levels < 36 mg/dl, and 295.83 € (149.63-406.59 €) with levels < 70 mg/dl. For an estimated replacement of NPH by IG of 4%, 7%, 10%, and 11% in four years, in Spain 6,772 hypoglycemic events would be avoided (487, 756, and 5,529, respectively, depending on its severity). The savings for the NHS would correspond to 1.6 million € (ranging from € 829,000 to 2.5 million €).

Conclusions

The treatment of diabetes type 2 with IG (vs. NPH), both administered at bedtime, could reduce the rate of nocturnal hypoglycemia and the associated costs for the NHS.