Costo-efectividad del tratamiento con insulina para el control de diabetes mellitus tipo 2 en México

Pablo  López-Esteves; Felipe  Rangel-Osuna; Jair  Yañez-Santaolalla; Amairani  Hernández-Castro; Abel Armando Arredondo-López

doi:10.19136/hs.a21n3.4769

Authors

Pablo López-Esteves National Institute of Public Health https://orcid.org/0000-0002-5545-8698
Felipe Rangel-Osuna National Institute of Public Health https://orcid.org/0000-0002-2269-9911
Jair Yañez-Santaolalla National Institute of Public Health https://orcid.org/0000-0001-9627-3430
Amairani Hernández-Castro National Institute of Public Health https://orcid.org/0000-0001-9226-7105
Abel Armando Arredondo-López Instituto Nacional de Salud Pública https://orcid.org/0000-0002-2768-9966

DOI:

https://doi.org/10.19136/hs.a21n3.4769

Abstract

Objective: To identify the best cost-effective intervention for the treatment of type 2 diabetes mellitus, at the first level of care, when the patient requires the use of insulin, based on previous clinical analysis.

Materials and methods: A cost-effectiveness analysis was carried out, from the provider perspective. The cost of three types of insulin as a control drug were obtained: glargine insulin, neutral protamine Hagedorn (NPH) insulin and lispro insulin/lispro protamine 25-75 IU. The effectiveness indicators were obtained from previous studies that analyzed the effect on glycated hemoglobin (HbA1c).

Results: The intervention that presented the best cost-effective coefficient was the treatment with glargine insulin, with a value of 570, compared to 643.1 for the NPH insulin and 57 for the lispro/lispro protamine insulin.

Conclusions: Glargine insulin is the treatment in patients who require insulins, without microvascular damage, that presents the best evidence to invest in, because of its cost and efficiency (analyzed through a cost-efficiency coefficient). These results may be considered in the Mexican context to improve drug’s acquisition and the treatment standards to treat type 2 diabetes mellitus.

Key words: Type 2 diabetes; Cost-effectiveness; Insulin

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Author Biographies

Pablo López-Esteves, National Institute of Public Health

Graduate in Political Science and International Relations. Master of Science student in Health Systems and Policies. National Institute of Public Health. Morelos. Mexico.
Felipe Rangel-Osuna, National Institute of Public Health

licensed psychologist who graduated from the Autonomous University of Baja California (UABC) in Tijuana in 2010. He also completed a binational diploma in substance addiction and related harm from the Colegio de la Frontera Norte (COLEF) and the University of California in San Diego (UCSD) in 2011, as well as a master's degree in public health from the National Institute of Public Health (INSP) in Cuernavaca, Morelos in 2016.
Rangel Osuna has also been certified as a facilitator in gender perspective by the Institute for Women in Morelos in 2018. His work experience includes collaborating with the prevention of HIV/AIDS and STIs at the Ambulatory Center for HIV/AIDS Prevention and Care (Capasits Tijuana) from September 2010 to March 2011, and working with the HIV/AIDS prevention and treatment module for deported migrants from July 2011 to July 2012. He has also worked as a researcher and surveyor for the INSP and the Fundación Mexicana para la Salud (Funsalud).
Rangel Osuna has worked on various projects related to public health, including "Strengthening National Prevention and Harm Reduction Strategies for MSM, MSM/TS, and IDUs of Both Genders," "Map of Health: Evolution of HIV/STI Risk Environments for Sex Workers on the Mexico/US Border," and "PROSPERA National Program Community Workshops' Short-Term Results Evaluation." He has also served as a normative liaison for the state program on HIV/AIDS and STIs in Morelos and worked as a facilitator of a violence prevention strategy for adolescents in the state's family and gender violence prevention and care program.
Currently, Rangel Osuna is pursuing a doctoral degree in health systems at the National Institute of Public Health, where he is working on his thesis titled "Comparative Analysis of Public Policies and Social Response to HIV and Type 1 Diabetes Mellitus in Mexico, 2010-2020." He is also assisting with research for the "Coexistence of Obesity and Anemia During Pregnancy" project, a collaboration between the Ibero-American University in Mexico City, INSP, the Mexican Social Security Institute (IMSS), and the University of Copenhagen
Jair Yañez-Santaolalla, National Institute of Public Health

Master in Public Health. Doctoral student in Health Systems Sciences. National Institute of Public Health. Mexico. Morelos. Mexico.
Amairani Hernández-Castro, National Institute of Public Health

Medical surgeon. Master of Science student in Health Systems and Policies. National Institute of Public Health. Mexico. Morelos. Mexico.
Abel Armando Arredondo-López, Instituto Nacional de Salud Pública

Licenciado en Medicina Maestro en Ciencias en Organización y Dirección de sistemas de Atención a la Salud Doctor en Ciencias de la Salud Profesor Investigador del Instituto Nacional de Salud Pública SNI III