Objective:To measure the economic value of a new insulin formulation consisting of rapid-acting insulin lispro and intermediate-acting neutral protamine lispro in a 25: 75 ratio (Humalog® Mix 25™).
Design and Setting: A cost-benefit analysis using a consumer-based willingness-to- pay (WTP) approach was used. The study sample consisted of 80 Canadian taxpayers randomly selected from Ontario and Quebec. After background information on the differences between Humalog® Mix 25™ and human 30/70 insulin were presented, respondents were asked what their preferred product would be if they were diagnosed with diabetes mellitus. Respondents were then asked the maximum premium that they would pay per month in the form of a user’s fee for the insulin of their choice.
Study Perspective: Canadian taxpayer perspective.
Main Outcome Measures and Results: The WTP survey instrument was simple to administer and easily understood by participants. Approximately 84% of the sample of taxpayers preferred to use Humalog® Mix 25™ rather than human 30/70 insulin and were willing to pay for it (p = 0.012). They were willing to pay a mean of $Can35.28 [95% confidence interval (CI): $Can27.50 to $Can43.07] per month for the benefits offered by Humalog® Mix 25™, which was at least 2-fold higher than the incremental monthly cost of the drug (1999 values).
Conclusions: The results of the study revealed that Canadians prefer to use Humalog® Mix 25™ instead of human 30/70 insulin, and they would be willing to pay for it. Compared with other drugs, this overall net gain suggests that Humalog® Mix 25™ represents good value for money and should be considered for reimbursement by government formularies and other third-party payers.
Insulin Lispro Nocturnal Hypoglycaemia Insulin Formulation Humalog Human Regular Insulin
This is a preview of subscription content, log in to check access
This study was funded by Eli Lilly Canada Inc.
Tan H, MacLean DR. Epidemiology of diabetes in Canada. Clin Invest Med 1995; 18: 240–6PubMedGoogle Scholar
Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med 1997; 14 Suppl. 5: S1–85CrossRefGoogle Scholar
Jonsson B. The economic impact of diabetes. Diabetes Care 1998; 21 Suppl. 3: C7–10Google Scholar
The Diabetes Control and Complications Trial Research Group. The effects of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–86CrossRefGoogle Scholar
Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995; 28: 103–17PubMedCrossRefGoogle Scholar
Howey DC, Bowsher RR, Brunelle R, et al. (Lys[B28], Pro[B29])- human insulin: a rapidly absorbed analogue of human insulin. Diabetes 1994; 43: 396–402PubMedCrossRefGoogle Scholar
Pfutzner A, Kustner E, Forst T, et al. Intensive insulin therapy with insulin Humalog in patients with type I diabetes reduces the frequency of hypoglycemic episodes. Exp Clin Endocrinol Diabetes 1996; 104: 25–30PubMedCrossRefGoogle Scholar
Anderson JH, Brunelle RL, Koivisto VA, et al. Reduction of postprandial hyperglycemia and frequency of hypoglycemia in IDDM patients on insulin-analog treatment. Diabetes 1997; 46: 265–70PubMedCrossRefGoogle Scholar
Davey P, Grainger DL, MacMillan J, et al. Clinical outcomes with insulin Humalog compared with regular insulin: a meta analysis. Clin Ther 1997; 19: 656–74PubMedCrossRefGoogle Scholar
Ebeling P, Jansson P, Smith U, et al. Strategies toward improved control during insulin lispro therapy in IDDM. Diabetes Care 1997; 20: 1287–9PubMedCrossRefGoogle Scholar
Jansson P, Ebeling P, Smith U, et al. Glycemic control in IDDM is improved by optimized combination of insulin lispro and basal insulin [abstract]. Diabetes 1997; 46 Suppl. 1: 162AGoogle Scholar
Koivisto VA, Tuominen JA, Ebeling P, et al. Humalog Mix 25 insulin as premeal therapy in type II diabetic patients. Diabetes Care 1999; 22: 459–62PubMedCrossRefGoogle Scholar
Malone JK, Woodworth JR, Arora V, et al. Improved postprandial glycemic control with Humalog Mix 75/25 after a standard test meal in patients with type 2 diabetes. Clin Ther 2000; 22: 222–30PubMedCrossRefGoogle Scholar
Lalli C, Ciofetta M, Del Sindaco P, et al. Long term intensive treatment of type 1 diabetics with the short acting insulin analog Humalog in variable combination with NPH insulin at mealtime. Diabetes Care 1999; 22: 468–77PubMedCrossRefGoogle Scholar
O’Brien B, Gafni A. When do the ‘dollars’ make sense? Toward a conceptual framework for contingent valuation studies in health care. Med Decis Making 1996; 16: 288–99PubMedCrossRefGoogle Scholar
Gafni A. Using willingness-to-pay as a measure of benefits: what is the relevant question to ask in the context of public decision making about health care problems? Med Care 1991; 29: 1246–52PubMedCrossRefGoogle Scholar
Roach P, Trautmann M, Arora V, et al. Improved postprandial blood glucose control and reduced nocturnal hypoglycemia during treatment with two novel insulin Humalog-protamine formulations, Insulin Humalog Mix 25 and Insulin Humalog Mix 50. Clin Ther 1999; 21: 523–34PubMedCrossRefGoogle Scholar
Torrance GW, Blaker D, Detsky A, et al. Canadian guidelines for economic evaluation of pharmaceuticals. Pharmacoeconomics 1996; 9: 535–59PubMedCrossRefGoogle Scholar
Meltzer S, Leiter L, Daneman D, et al. Clinical practice guidelines for the management of diabetes in Canada. Can Med Assoc J 1998; 159 Suppl. 8: S1–29Google Scholar
Mitchell RC, Carson RT. A contingent valuation estimate of national freshwater benefits: technical report to the U.S. environmental protection agency. Washington, DC: Resources for the Future, 1984Google Scholar
Davey P, Grainger D, MacMillan J, et al. Economic evaluation of insulin Humalog versus neutral insulin therapy using a willingness to pay approach. Pharmacoeconomics 1998; 13: 347–58PubMedCrossRefGoogle Scholar
George SL. Identification and assessment of prognostic factors. Semin Oncol 1988; 15: 462–71PubMedGoogle Scholar
Feinstein AR. Multivariate analysis: an introduction. New Haven (CT): Yale University Press, 1996Google Scholar
Cresswell JW. Qualitative inquiry and research design: choosing among five traditions. Thousand Oaks (CA): Sage, 1998Google Scholar
Ortega A, Dranitsaris G, Puodziunas A. What are cancer patients willing to pay for epoetin alfa: a cost-benefit analysis. Cancer 1998; 83: 2588–96PubMedCrossRefGoogle Scholar