AimTo provide estimates of the costs of severe and non‐severe insulin‐related hypoglycaemia in the UK using the Local Impact of Hypoglycaemia Tool.MethodsRates of hypoglycaemia were extracted from the UK Hypoglycaemia Study Group observational study. The costs of severe and non‐severe hypoglycaemic episodes in insulin‐treated adults with Type 1 and Type 2 diabetes were estimated from UK data sources. The rates and costs were then applied to specific populations to give an estimate of the cost of insulin‐related hypoglycaemia for the UK, a specific locality, or a user‐defined population. User‐specific rates and costs could also be applied.ResultsThe estimated cost of a hypoglycaemic episode can range from as much as £2,152 for severe episodes (for which the patient is admitted to hospital) to as little as £1.67 for non‐severe episodes. With a UK population of 64.1 million, the total estimated cost of managing insulin‐related hypoglycaemia is £468.0 m per year (£295.9 m for severe episodes, £172.1 m for non‐severe episodes). On a local health economy level, using a hypothetical general population of 100 000, the total cost of managing insulin‐related hypoglycaemia is estimated to be £730,052 per year (£461,658 for severe and £268,394 for non‐severe episodes).ConclusionsThe Local Impact of Hypoglycaemia Tool highlights the economic burden of insulin‐related hypoglycaemia. Non‐severe episodes are often overlooked because of their low individual cost, but their high frequency makes the cumulative cost substantial. The Local Impact of Hypoglycaemia Tool also shows clinicians and budget‐holders the economic impact of lower rates of hypoglycaemia.

IntroductionThe glucagon-like peptide-1 (GLP-1) receptor agonist class has grown in the last decade, with several agents available in the UK. However there is currently a paucity of evidence regarding the relative cost-effectiveness of liraglutide 1.2 mg versus other daily administered GLP-1 receptor agonists, due to a lack of head-to-head trial data. Therefore the present analysis was performed, using results from a network meta-analysis (NMA), to compare the cost-effectiveness of three currently available daily administered GLP-1 receptor agonists for treatment of diabetes in the UK setting.MethodsA validated and published diabetes model was used to make long-term projections of clinical outcomes and direct costs (2015 GBP) for patients receiving liraglutide 1.2 mg once-daily, exenatide 10 μg twice daily and lixisenatide 20 μg once-daily. Treatment effects were taken from an NMA evaluating the efficacy of GLP-1 receptor agonists and were applied in a cohort based on the Liraglutide Effect and Action in Diabetes 6 (LEAD-6) trial. Costs and utilities were based on published sources.ResultsLiraglutide 1.2 mg was associated with improved quality-adjusted life expectancy versus exenatide [9.19 versus 9.17 quality-adjusted life years (QALYs)] and lixisenatide (9.19 versus 9.12 QALYs). Improvements were driven by benefits in glycemic control, leading to a reduced incidence of diabetes-related complications. Liraglutide 1.2 mg was associated with reduced costs versus exenatide (GBP 36,394 versus GBP 36,547) and lixisenatide (GBP 36,394 versus GBP 36,496), with cost savings as a result of complications avoided entirely offsetting increased acquisition costs. Based on the projected outcomes, liraglutide was found to be dominant over both exenatide and lixisenatide.ConclusionLiraglutide 1.2 mg is likely to be considered cost-effective versus alternative daily administered GLP-1 receptor agonists for treatment of type 2 diabetes in the UK.

Introduction:Management of type 2 diabetes mellitus (T2DM) often requires intervention with oral and injectable therapies. Across National Health Service (NHS) England, injectable therapies may be initiated in secondary, intermediate or primary care. We wished to understand resource utilization, pathways of care, clinical outcomes, and experience of patients with T2DM initiated on injectable therapies.Method:We conducted three service evaluations of initiation of injectable therapies (glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or basal insulin) for T2DM in primary, secondary and intermediate care. Evaluations included retrospective review of medical records and service administration; prospective evaluation of NHS staff time on each episode of patient contact during a 3-month initiation period; patient-experience survey for those attending for initiation. Data from each evaluation were analysed separately and results stratified by therapy type.Results:A total of 133 patients were included across all settings; 54 were basal-insulin initiations. After initiation, the mean HbA1c level fell for both types of therapies, and weight increased for patients on basal insulin yet fell for patients on GLP-1 RA. The mean cost of staff time per patient per initiation was: £43.81 for GLP-1 RA in primary care; £243.49 for GLP-1 RA and £473.63 for basal insulin in intermediate care; £518.99 for GLP-1 RA and £571.11 for basal insulin in secondary care. Patient-reported questionnaires were completed by 20 patients, suggesting that patients found it easy to speak to the diabetes team, had opportunities to discuss concerns, and felt that these concerns were addressed adequately.Conclusion:All three services achieved a reduction in HbA1c level after initiation. Patterns of weight gain with basal insulin and weight loss with GLP-1 RA were as expected. Primary care was less resource-intensive and costly, and was driven by lower staff costs and fewer clinic visits.

Background:Fast-acting insulin aspart is a new formulation of the rapid-acting insulin analogue insulin aspart and represents an advancement over current rapid-acting insulin analogues in terms of onset of action and postprandial glucose control. The objective of the current analysis was to demonstrate the cost impact of prescribing fast-acting insulin aspart instead of insulin aspart, to highlight the value of fast-acting insulin aspart for the treatment of people with diabetes requiring mealtime insulin.Methods:A cost-impact analysis was conducted from the perspective of the UK National Health Service (NHS). The analysis excluded patients’ out-of-pocket expenses, carers’ costs and lost productivity. The time horizon of the analysis was 1 year, and no discounting was therefore applied.Results:The displacement of insulin aspart with fast-acting insulin aspart is cost neutral for the UK NHS. Fast-acting insulin aspart is at price parity to insulin aspart in terms of the vial and Penfill® cartridge and is available in the FlexTouch® pen at the same price as the insulin aspart FlexPen® (and thus cheaper than the insulin aspart FlexTouch® pen). Patients using the insulin aspart FlexPen® will be upgraded to the FlexTouch® pen device, which is preferred by patients and healthcare professionals, on switching to fast-acting insulin aspart, at no additional cost.Conclusions:Fast-acting insulin aspart offers additional clinical benefit but at no additional cost when compared with insulin aspart, and thus provides value to the UK NHS.

features 64 health states for every combination of study/nonstudy eye, and a health state representing death, derived from the VIVID/VISTA-DME and RESTORE/REVEAL studies. Economic inputs were based on the experts' opinions.2 The primary and secondary endpoints for the study were life years gained and quality-adjusted life years (QALY), and years with 1 eye blind, respectively. Incremental cost-effectiveness ratios (ICER) were calculated per QALY and years with 1 eye blind. Analyses were conducted from the payer perspective and time horizon was lifetime. All costs were calculated in Turkish Lira (TL). Results: Total annual costs associated with IVT-AFL and ranibizumab were 15,315 and 14,791 TL, respectively. QALYs were 7.343 with IVT-AFL and 7.295 ranibizumab. According to the results of the analysis, IVT-AFL is a cost effective treatment option when compared with ranibizumab at a costeffectiveness threshold of 26,415 TL (calculated threshold from developing country defined as 3-fold of annual income per capita, per the World Health Organization). The ICER of IVT-AFL versus ranibizumab was 10,866 TL/QALY. Years with 1 eye blind were 0.416 with IVT-AFL and 0.647 with ranibizumab, with a difference of 0.231 year in favor of IVT-AFL, giving an ICER of 2268 TL/years with 1 eye blind. ConClusions: IVT-AFL may be a cost-effective treatment option when compared with ranibizumab for treatment of DME in Turkey.