Cost-effectiveness of insulin regimens and insulin types for adults with type 1 diabetes: a systematic review

To assess the global cost-effectiveness of insulin regimens, comparing long- and short-acting insulin analogues to human insulins, in adults with T1D.

Systematic review (CRD420250654279). We searched MEDLINE, Embase, Web of Science, WHO Global Index Medicus, and the HTA database on 17 March 2025. We included full economic evaluations comparing insulin regimens for adults with T1D. Incremental Cost Effectiveness Ratios (ICERs) and Incremental Cost Utility Ratios (ICURs) were converted and adjusted into a common currency (2024 US dollar) using purchasing power parity. The SBU and the CHEERS checklists were used for quality assessment.

We included 35 studies, covering 50 insulin comparisons across 19 countries, predominantly in Europe. Most studies were model-based (97%) and industry-funded (86%). Several studies indicated that analogue-based regimens may be cost-effective under study-specific assumptions (ICURs ranging from USD 4,550 to 10,720.28 per QALY). Among 35 comparisons of long-acting insulins, findings were mixed: ICERs ranged from USD 17 to 10,940 per 1% HbA1c reduction, and ICURs ranged from USD 102 to 124 million per QALY. Short-acting insulins were also cost-effective (ICERs ranging from USD 88 to 7,844 per 1% HbA1c annual reduction per patient; ICURs from USD 7,382 to 34,769 per QALY).

Long- and short-acting insulin analogues are often reported to be cost-effective compared with human insulins in adults with T1D, but this conclusion rests on an evidence base with recurrent methodological limitations, wide statistical uncertainty and a high risk of sponsor-related bias and limited evidence from low- and lower-middle-income countries.