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Commentary: Does additional benefit justify additional costs of insulin analogues?

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5858 (Published 14 September 2011) Cite this as: BMJ 2011;343:d5858
  1. Peter T Sawicki, professor of medicine
  1. 1Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
  1. peter.sawicki{at}uk-koeln.de

Late in 2004, the German Health Ministry held a conference that aimed to improve outcomes and cost-benefit relations in the treatment of chronic diseases. The ministry was concerned that the increasing costs of treatment were not accompanied by an improvement in patient relevant outcomes. As a consequence, in 2005 the Joint Federal Committee—the top decision body of the German healthcare system—commissioned the Institute for Quality and Efficiency in Health Care (IQWiG) with the assessment of diagnostic and therapeutic interventions in chronic diseases, including diabetes. In this context, the Institute assessed the additional benefit of short and long acting insulin analogues compared with that achieved with human insulin.

The methods used by the Joint Federal Committee and IQWiG aimed to evaluate a direct proof of benefit with regard to patient oriented outcomes or valid surrogate parameters.1 2 They required such parameters to be assessed in appropriate randomised controlled clinical trials, and non-randomised observational studies were regarded …

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