Cost-effectiveness and budget impact of liraglutide in type 2 diabetes patients with elevated cardiovascular risk: a US-managed care perspective

Abstract

BackgroundThe Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcomes Results (LEADER) clinical trial demonstrated that liraglutide added to standard-of-care (SoC) therapy for type 2 diabetes (T2D) with established cardiovascular disease (CVD) or elevated cardiovascular (CV) risk was associated with lower rates of death from CVD, nonfatal myocardial infarction (MI), or nonfatal stroke than SoC alone.ObjectiveThe objective of this study was to assess the cost-effectiveness (CE) and budget impact of liraglutide vs SoC in T2D patients with established CVD or elevated CV risk, over a lifetime horizon from a US managed care perspective.MethodsA cohort state-transition model (costs and benefits discounted at 3% per year) was used to predict diabetes-related complications and death (CV and all-cause). Events, treatment effects, and discontinuation rates were from LEADER trial; utility and cost data (US$, 2017) were from literature. Sensitivity analysis explored the impact of uncertainty on results. Additionally, a budget impact analysis was conducted to evaluate the financial impact of liraglutide use in this population, with displacement from dulaglutide, assuming a health care plan with 1 million members.ResultsLiraglutide patients experienced 6.3% fewer events, had event-related cost-savings of $15,182, gained additional life-years of 0.67 and quality-adjusted life-years (QALYs) of 0.57, and had additional total costs ($60,928) vs SoC. Liraglutide was cost-effective with an incremental CE ratio of $106,749/QALY which was below the willingness-to-pay threshold of $150,000/QALY accepted by the Institute of Clinical and Economic Research. Liraglutide was cost-effective across all sensitivity analyses, except when the hazard ratio for all-cause mortality varied. The budget impact was neutral, with a per-plan-per-year and per-member-per-month cost-savings of $266,334 and $0.02, respectively.ConclusionFrom a US-managed care perspective, for T2D patients with established CVD or elevated CV risk, liraglutide is a cost-effective and a budget neutral treatment option for health care plans.

Exploring Why People With Type 2 Diabetes Do or Do Not Persist With Glucagon-Like Peptide-1 Receptor Agonist Therapy: A Qualitative Study

“…Glucagon-like peptide 1 (GLP-1) receptor agonists are an innovative class of medications for people with type 2 diabetes that enhances glucose-dependent insulin secretion, suppresses pancreatic glucagon production, slows gastric motility, and reduces body weight by increasing satiety and decreasing appetite (1,2). Importantly, treatment with a GLP-1 receptor agonist confers a low risk of hypoglycemia when given as monotherapy or in the absence of sulfonylureas or insulin (2), and recent studies have linked certain GLP-1 receptor agonist formulations with cardiovascular (3)(4)(5) and renal (3,4,6,7) benefits, as well as cost savings (8)(9)(10).…”

A Budget Impact Analysis of Substituting Sitagliptin with Liraglutide in Type 2 Diabetes from A Private Health Insurance Perspective in Egypt

“…Over the lifetime of T2DM patients included in the analysis and with con rmed cardiovascular disease or high cardiovascular risk, liraglutide use was budget neutral and cost-effective [13].…”

Budget Impact Analysis of Diabetes Drugs: A Systematic Literature Review

“…Among the five basal insulin BIA studies, one of them was about insulin glargine biosimilar (13). The rest of BIA studies targeted GLP-1 RA (n = 4, including once-weekly semaglutide, oral semaglutide, and benaglutide) (12,14,25,27), DPP-4i (n = 3, including vildagliptin, saxagliptin, and linagliptin) (10,15,23), SGLT-2i (n = 2, both were dapagliflozin) (11,17) and metformin (n = 1) (19).…”

“…The majority of studies (n = 13) (10-12, 14-17, 19, 22-25, 27) restricted the target population on type 2 diabetes patients while some targeted type 1 diabetes patients (n = 2) (18,21), or type 1 and type 2 diabetes patients (n = 2) (20,26), and one study did not specify the target population (13). Six studies estimated the eligible population size based on a hypothetical health plan (20,(23)(24)(25)(26)(27), of which the assumed size varied widely ranging from 1 million to 35 million. All but one (23) of these studies reported the specific number of target population.…”