ArticlePloS one2026
Economic evaluation of insulin glargine compared with human insulin for youth with type 1 diabetes in Tanzania and Bangladesh.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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13 authors.
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Abstract
backgroundLong-acting insulin analogues are the standard of care for Type 1 diabetes (T1D) in high-income countries but remain inaccessible in many low-resource settings. Cost-effectiveness is a key consideration for their adoption. This analysis evaluated the cost-effectiveness of biosimilar insulin glargine (IGlar) versus neutral protamine Hagedorn (NPH) insulin in youth with T1D in Tanzania and Bangladesh.
methodsData from the HumAn-1 trial informed a short-term economic model comparing NPH and IGlar over 12 months. The analysis, conducted from a health systems perspective, incorporated micro-costing data for insulin, injection supplies, blood glucose monitoring, and estimated hospitalization costs for complications. Effectiveness was based on a reduction in nocturnal hypoglycemia. In both countries, we calculated incremental cost-effectiveness ratios per quality-adjusted life year (QALY) gained in scenarios that compared IGlar against NPH across delivery devices (i.e., vials, cartridges, single-use pens).
resultsIGlar was cost-effective compared to NPH when provided in cartridges in Bangladesh at a threshold of three times gross domestic product per capita. Other delivery devices in Bangladesh and all options in Tanzania were not cost-effective at current prices. If offered, IGlar vials would be cost-effective in Tanzania and Bangladesh if the price introduced was no more than 32% or 134% higher, respectively, than the current prices of NPH vials. Annual per patient costs and other cost-effectiveness thresholds were explored.
conclusionIn low-resource settings, IGlar can be a cost-effective alternative to NPH, largely due to reduced nocturnal hypoglycemia, but the delivery device for the insulin has a major impact on the costs and cost-effectiveness comparisons.
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