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MICHAEL F. BULLANO, PHARM.D., is Associate Director, Health Economics and Outcomes Research, AstraZeneca, Wilmington, DE; at the time of writing he was Director, Health Outcomes Research, HealthCore, Inc., Wilmington. MAXINE D. FISHER, PH.D., is Senior Clinical Analyst and Medical Writer, Health Outcomes Research; and W. DANIEL GROCHULSKI, PH.D., is Analytics Manager, Health Outcomes Research, HealthCore, Inc. LAURA MENDITTO, M.P.H., M.B.A., is Director, US Health Outcomes, GlaxoSmithKline, Philadelphia, PA; at the time of writing she was Director, Metabolism Health Outcomes, Sanofi-Aventis, Bridgewater, NJ. VINCENT J. WILLEY, PHARM.D., is Vice President, Health Outcomes Research, HealthCore, Inc.

Address correspondence to Dr. Bullano at AstraZeneca, 1800 Concord Pike, C3C-702, Wilmington, DE 19850-5347 (michael.bullano{at}astrazeneca.com).

Purpose. Rates of hypoglycemic events and their associated costs were compared among patients with type 2 diabetes mellitus newly initiated on insulin glargine or a premixed insulin fixed-combination product. Methods. Patients newly initiated on insulin glargine or premixed insulin fixed-combination products (including pen delivery systems) between June 1, 2001, and February 29, 2004, were identified using an administrative claims database. Hypoglycemic events were identified from International Classification of Diseases, 9th Revision, Clinical Modification codes. Multivariate analyses were performed. Results. A total of 2315 patients met the inclusion criteria. Of those, 1212 received insulin glargine and 1103 received a premixed fixed-combination insulin product. The mean ± S.D. treatment duration was 13.7 ± 8.1 months. Patients treated with premixed insulin had a higher hypoglycemic event rate than glargine patients (13.8 versus 7.0/100 patients/year; p = 0.027), which yielded a number needed to treat of 15 patients. The mean cost per hypoglycemic event was $1049 (95% confidence interval, $426–1672). The mean annual cost of all insulin use was $46 more for the insulin glargine cohort than for those who received premixed insulin ($534 versus $488, respectively) (p < 0.05). Mean postindex insulin use was higher in patients receiving premixed insulin than in those treated with insulin glargine (48.1 versus 43.8 units per day) (p < 0.05). Conclusion. Patients with type 2 diabetes mellitus who were newly initiated on insulin glargine had a lower rate of hypoglycemic events compared with patients newly initiated on a premixed fixed-combination insulin product. Treatment of 15 patients with insulin glargine instead of premixed insulin for one year would avoid one hypoglycemic event per year. Index terms: Costs; Diabetes mellitus; Drug comparisons; Economics; Hypoglycemia; Insulin glargine; Insulins; Toxicity