Cost Effectiveness of Insulin Degludec Plus Liraglutide (IDegLira) in a Fixed Combination for Uncontrolled Type 2 Diabetes Mellitus in Sweden

Abstract

BackgroundPatients with uncontrolled type 2 diabetes mellitus (T2DM) are a priority group for intensified therapy without weight gain and with low risk of hypoglycaemia.ObjectiveThis study evaluates the cost effectiveness of insulin degludec plus liraglutide (IDegLira, Xultophy®) compared with six potential intensification treatment options for patients with T2DM that is uncontrolled with basal insulin.MethodsThe Swedish Institute for Health Economics (IHE) Cohort Model of Type 2 Diabetes was used with Swedish input data, a 40-year time frame and a societal perspective. The comparators for treatment intensification included insulin glargine, neutral protamine Hagedorn (NPH) insulin, insulin aspart plus either glargine or NPH, and liraglutide plus either glargine or NPH. Clinical data for all comparators (except NPH insulin) were based on an indirect treatment comparison of several studies. Prices were obtained from the 2014 Swedish Dental and Pharmaceutical Benefits Agency (Tandvårds- och läkemedelsförmånsverket [TLV]) database, and utility values were obtained from published studies. Sensitivity analyses were undertaken.ResultsOverall incremental cost-effectiveness ratios (ICER) were Swedish krona (SEK) 70,000 or lower per quality-adjusted life-year (QALY). IDegLira compared with intensified basal insulin showed an ICER of SEK 28,000 per QALY versus insulin glargine, SEK70,000 per QALY versus NPH insulin and SEK 60,000 per QALY versus NPH insulin plus liraglutide. IDegLira was dominant over insulin glargine plus liraglutide and insulin aspart plus insulin glargine or NPH insulin. Results were driven by the difference in glycated haemoglobin (HbA1c) reduction between treatments, as confirmed by sensitivity analyses.ConclusionsIDegLira is estimated to be a cost-effective treatment in Sweden compared with commonly used intensification treatments for patients with T2DM uncontrolled with basal insulin.Electronic supplementary materialThe online version of this article (doi:10.1007/s40258-016-0301-y) contains supplementary material, which is available to authorized users.

Evaluating the long‐term cost‐effectiveness of fixed‐ratio combination insulin degludec/liraglutide (IDegLira) for type 2 diabetes in Spain based on real‐world clinical evidence

“…These findings are consistent with other published health economic analyses of IDegLira. Cost‐effectiveness evaluations based on clinical trial data on IDegLira have shown that it is likely to improve clinical outcomes and be cost‐effective versus several comparator regimens (basal insulin, basal‐bolus insulin, and GLP‐1 receptor agonists in combination with insulin) in patients with type 2 diabetes in the United States, the Netherlands, the Czech Republic, Sweden, the United Kingdom and Spain . Comparable health economic outcomes from the present study based on real‐world evidence are reassuring, as they indicate that the benefits of IDegLira observed in RCTs translate to the real‐world setting, and that similar improvements in long‐term outcomes with IDegLira can be anticipated for patients in routine clinical practice.…”

Cost-effectiveness of once-weekly semaglutide versus dulaglutide and lixisenatide in patients with type 2 diabetes with inadequate glycemic control in Sweden

“…The validation indicated that the model has a predictive accuracy in line with other models of T2D. This model is applicable to CEAs of diabetes in Sweden as it is based on Swedish risks, healthcare system, and costs [27][28][29] .…”

“…These CEAs were conducted using the IHE Diabetes Cohort Model 26 , which has been used in other CEAs in Sweden [27][28][29] . Briefly, this model uses cohort simulation to estimate the cost-effectiveness of competing interventions for T2D.…”

An indirect treatment comparison of the efficacy of insulin degludec/liraglutide (IDegLira) and insulin glargine/lixisenatide (iGlarLixi) in patients with type 2 diabetes uncontrolled on basal insulin

“…These improvements may provide substantial cost savings for healthcare payers through reduced expenditure on the treatment of diabetesrelated complications 33 . Evidence from available cost-effectiveness analyses further support the role of HbA 1c and BMI in determining long-term outcomes; improvements in which have been shown to offset higher initial treatment costs 34,35 . The estimated relative treatment effects for IDegLira vs iGlarLixi, derived from this indirect treatment comparison, could be used as a basis for future cost-effectiveness analyses.…”