Cost-effectiveness of Insulin Degludec Versus Insulin Glargine in Adults with Type 1 and Type 2 Diabetes Mellitus

Abstract

IntroductionTo estimate the cost-effectiveness of insulin degludec (IDeg) versus insulin glargine U100 (IGlar U100) and new-to-market basal insulin analogues in patients with diabetes in order to aid decision-making in a complex basal insulin market.MethodsA simple, short-term model was used to evaluate the costs and effects of treatment with IDeg versus IGlar U100 over a 12-month period in patients with type 1 (T1DM) and type 2 diabetes (T2DM) from the perspective of the UK National Health Service. New-to-market basal insulin analogues were evaluated in scenario analyses.ResultsIDeg is dominant (more effective and less costly) versus IGlar U100 in patients with T1DM and patients with T2DM on a basal-only therapy regimen (T2DMBOT), and is cost-effective versus IGlar U100 in patients with T2DM on a basal-bolus regimen (T2DMB/B). In T1DM, lower costs are primarily driven by lower insulin costs, as a result of a lower daily dose of IDeg. In T2DMBOT, lower overall costs with IDeg are driven by lower costs of severe hypoglycaemic events due to the significant reduction in number of events with IDeg versus IGlar U100. Improvements in clinical outcomes in all three patient groups are a result of the reduced incidence of hypoglycaemic events. Sensitivity analyses demonstrate that the results are robust. Scenario analyses versus two new-to-market basal insulin analogues indicate that in patients with T1DM and T2DMBOT, IDeg is likely to be highly cost-effective versus IGlar biosimilar Abasaglar® and dominant versus IGlar U300 (Toujeo®). In T2DMB/B, IDeg is likely to be cost-effective versus both comparators, with incremental cost-effectiveness ratios (ICERs) below the accepted threshold.ConclusionIDeg is a cost-effective alternative to IGlar U100 for patients with diabetes in the UK, and it also likely to be cost-effective versus two new-to-market basal insulin analogues.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0236-9) contains supplementary material, which is available to authorized users.

Superior efficacy of insulin degludec/liraglutide versus insulin glargine U100 as add‐on to sodium‐glucose co‐transporter‐2 inhibitor therapy: A randomized clinical trial in people with uncontrolled type 2 diabetes

“…Previous trials have established the efficacy and safety of the combination of GLP‐1RAs and SGLT2 inhibitors; we have demonstrated the same in participants with T2D uncontrolled on SGLT2 inhibitors, albeit with a fixed‐ratio combination of GLP‐1RA and basal insulin, versus basal insulin, as an add‐on to SGLT2 inhibitor ± OADs.…”

“…IDegLira is a fixed‐ratio combination of the basal insulin degludec and the GLP‐1RA liraglutide; the safety and efficacy of IDegLira have been demonstrated in a variety of patient populations in the DUAL clinical trial programme . In the DURATION‐8 and AWARD‐10 clinical trials, combined therapy with GLP‐1RAs and SGLT2 inhibitors in patients failing to achieve glycaemic control on metformin and SGLT2 inhibitor ± metformin, respectively, resulted in improvements in glycaemic control, with no unexpected side effects. Treatments belonging to the GLP‐1RA and SGLT2 inhibitor classes of medications exert their positive effects on patients by different, but complementary, modes of action.…”

A comparative effectiveness study of degludec and insulin glargine 300 U/mL in insulin‐naïve patients with type 2 diabetes

“…The BRIGHT study found that equivalent glycaemic control was possible with degludec, at a 20% lower dose than that of glargine U300 . These results may suggest that there are potential economic benefits with the use of degludec vs glargine U300; however, this must be explored further in additional studies, with different healthcare systems and patient populations, to support the limited data currently available …”

Short‐term cost‐utility of degludec versus glargine U100 for patients with type 2 diabetes at high risk of hypoglycaemia and cardiovascular events: A Canadian setting (DEVOTE 9)

“…Other CEAs of degludec vs glargine U100, from a public healthcare payer perspective, have reported similar findings; degludec is a dominant or cost‐effective treatment option in patients with T2D across treatment regimens, in each respective setting . To date, these have all been informed by data from phase 3, treat‐to‐target clinical trials that have focused on the short‐term effects of hypoglycaemia rates and insulin dosing over a 1‐year time horizon in a European setting .…”

“…17 Prior to the DEVOTE trial, CEAs of degludec compared with glargine U100 captured the effects of hypoglycaemia rates and insulin dosing over a short-term (1-year) time horizon in patients with type 1 (T1D) or type 2 (T2D) diabetes, based on the phase 3 clinical trial programme. [18][19][20][21][22][23] The DEVOTE trial provided an opportunity to evaluate randomized, double-blind clinical trial data, including cardiovascular endpoints and death, in addition to severe hypoglycaemia rates and insulin dosing, to provide health economic analyses of degludec vs glargine U100 over a 2-year time horizon without extrapolation.…”