IntroductionThis study investigates the cost-effectiveness of insulin degludec versus insulin glargine U100 in patients with type 1 and type 2 diabetes mellitus in Serbia.MethodsA cost-utility analysis, implementing a simple short-term model, was used to compare treatment costs and outcomes with degludec versus glargine U100 in patients with type 1 (T1DM) and type 2 diabetes (T2DM). Cost-effectiveness was analysed in a 1-year setting, based on data from clinical trials. Costs were estimated from the healthcare payer perspective, the Serbian Health Insurance Fund (RFZO). The outcome measure was the incremental cost-effectiveness ratio (ICER) or cost per quality-adjusted life-year (QALY) gained.ResultsDegludec is highly cost-effective compared with glargine U100 for people with T1DM and T2DM in Serbia. The ICERs are estimated at 417,586 RSD/QALY gained in T1DM, 558,811 RSD/QALY gained in T2DM on basal oral therapy (T2DMBOT) and 1,200,141 RSD/QALY gained in T2DM on basal-bolus therapy (T2DMB/B). All ICERs fall below the commonly accepted thresholds for cost-effectiveness in Serbia (1,785,642 RSD/QALY gained). In all three patient groups, insulin costs are higher with degludec than with glargine U100, but these costs are partially offset by savings from a lower daily insulin dose in T1DM and T2DMBOT, a reduction in hypoglycaemic events in all three patient groups and reduced costs of SMBG testing in the T2DM groups with degludec versus glargine U100.ConclusionDegludec is a cost-effective alternative to glargine U100 for patients with T1DM and T2DM in Serbia. Degludec may particularly benefit those suffering from hypoglycaemia or where the patient would benefit from the option of flexible dosing.FundingNovo Nordisk.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0426-0) contains supplementary material, which is available to authorized users.

A 3 4 7 -A 7 6 6 reported clinical inputs utilised in economic models: reduction in HbA1c levels (49 studies), hypoglycaemic events (39 studies), change in BMI (30 studies), change in systolic blood pressure (SBP, 23 studies), change in body weight (19 studies), and change in lipid biomarkers (17 studies); 28 studies reported utility inputs: hypoglycaemia (20 studies), BMI (12 studies), and T2DM-related cardiovascular-(12 studies), renal-(11 studies), and eye-complications (11 studies). Six studies for SGLT-2 inhibitors considered urinary tract and genital infections (key SGLT-2 inhibitors adverse events [AEs]), which indicate increased interest in treatment-related AEs besides the regular clinical effectiveness inputs. Among assessed studies, key cost drivers for insulins were HbA1c change (9 studies), hypoglycaemia event rate (10 studies), and T2DM-related complications (5 studies). For GLP-1 analogues, key cost drivers were changes in utilities associated with weight change, BMI, and nausea. For SGLT-2 inhibitors, key cost drivers were weight/BMI change, HbA1c change, and SBP change. ConClusions: HbA1c levels and hypoglycaemic event rates dominate economic evaluations for T2DM and with T2DM-related complications were found to be key cost-drivers for insulin-based regimens. However, weight/BMI were identified as key cost-drivers for GLP-1 analogues and SGLT-2 inhibitors.objeCtives: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodiumglucose co-transporter 2 inhibitors (SGLT-2i) are both indicated for the treatment of Type 2 diabetes mellitus (T2DM). Liraglutide and dapagliflozin are the most commonly prescribed GLP-1RA and SGLT-2i treatments in Spain, respectively. This study investigated the cost-effectiveness of liraglutide versus dapagliflozin for the treatment of T2DM in Spain. Methods: The IMS CORE Diabetes Model (CDM), a validated simulation model, was used to estimate expected costs and outcomes. Patients with T2DM who had failed prior therapy with metformin received liraglutide 1.2mg or 1.8mg as interventions versus dapagliflozin 10mg as comparator, in addition to continuing metformin (dual therapy). Comparative efficacy was extracted from a network meta-analysis. Utility inputs came from a systematic literature review. A Spanish national payer perspective was assumed and analysis run over a lifetime time horizon. Sensitivity analysis considered a cohort receiving liraglutide or dapagliflozin in combination with two other anti-diabetic drugs (triple therapy). Results: In dual therapy, liraglutide 1.2mg resulted in a QALY gain of 0.07 vs dapagliflozin 10mg at an additional cost of € 421 (ICER: € 6,486 per QALY gained), whereas results for liraglutide 1.8mg found a QALY gain of 0.08 at an additional cost of € 1,480 (ICER: € 17,966 per QALY gained). In triple therapy, QALY gain with liraglutide 1.2mg vs dapagliflozin 10mg was similar (0.07) and incremental cost was € 578 (ICER: € 8,932 per QALY gained), while increases in efficacy and costs were observed for liraglutide 1.8mg (ICER: € 17,703 per ...