Cost-Effectiveness of Insulin Degludec Versus Insulin Glargine U100 in Patients with Type 1 and Type 2 Diabetes Mellitus in Serbia

Lalić, Nebojša; Russel-Szymczyk, Monika; Culic, Marina; Tikkanen, Christian Klyver; Chubb, Barrie

doi:10.1007/s13300-018-0426-0

Cited by 12 publications

(16 citation statements)

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“…In the United Kingdom (UK) and Denmark, degludec was found dominant versus glargine U100 in T1DM and T2DM BOT and highly cost-effective in T2DM B/B [33,39]. Similarly, in Serbia and Sweden, degludec was cost-effective versus glargine U100 in all three patient groups [34,38]. These results are consistent with those observed in the current study.…”

Section: Discussionsupporting

confidence: 91%

“…This is supported by the insensitivity of the ICER to changes in the time horizon in the sensitivity analyses. The model has previously been used to evaluate the cost-effectiveness of degludec versus glargine U100 in patients with T1DM and T2DM in different settings [33,34,[38][39][40][41].…”

Section: Discussionmentioning

confidence: 99%

“…The methods used to derive hypoglycaemia cost (summarised in Table 1) have been reported previously [34]. It was assumed that the cost of treating a severe or non-severe hypoglycaemic event (diurnal and nocturnal) was similar regardless of whether the event was experienced by patients with T1DM, T2DM BOT or T2DM B/B .…”

mentioning

confidence: 99%

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Cost-effectiveness of insulin degludec versus insulin glargine U100 in adults with type 1 and type 2 diabetes mellitus in Bulgaria

Russel-Szymczyk

Valov

Savova

et al. 2019

Preprint

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Background This study investigates the cost-effectiveness of insulin degludec (degludec) versus biosimilar insulin glargine U100 (glargine U100) in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in Bulgaria.Methods A simple, short-term model was used to compare the treatment costs and outcomes associated with hypoglycaemic events with degludec versus glargine U100 in patients with T1DM and T2DM from the perspective of the Bulgarian National Health Insurance Fund. Cost-effectiveness was analysed over a 1-year time horizon using data from clinical trials. The outcome measure was the incremental cost-effectiveness ratio (ICER).Results Degludec was highly cost-effective versus glargine U100 in people with T1DM and T2DM in Bulgaria. The ICERs were estimated to be 4,493.68 BGN/quality-adjusted life year (QALY) in T1DM, 399.11 BGN/QALY in T2DM on basal oral therapy (T2DM BOT ) and 7,365.22 BGN/QALY in T2DM on basal bolus therapy (T2DM B/B ), which all fall below the cost-effectiveness threshold of 39,619 BGN in Bulgaria. Insulin costs were higher with degludec in all three patient groups, however these were partially offset by savings from a reduction in hypoglycaemic events with degludec versus glargine U100. Sensitivity analysis demonstrated that the results were robust and largely insensitive to variations in input parameters. At a willingness-to-pay threshold of 39,619 BGN/QALY, the probability of degludec being cost-effective versus glargine U100 was 60.0% in T1DM, 99.4% in T2DM BOT and 91.3% in T2DM B/B .ConclusionDegludec is a cost-effective alternative to biosimilar glargine U100 for patients with T1DM and T2DM in Bulgaria. Degludec could be of particular benefit to those patients suffering recurrent hypoglycaemia and those who require additional flexibility in the dosing of insulin.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness of insulin degludec versus insulin glargine U100 in adults with type 1 and type 2 diabetes mellitus in Bulgaria

Russel-Szymczyk

Valov

Savova

et al. 2019

Preprint

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“…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 .…”

Section: Discussionmentioning

confidence: 79%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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)

Pollock¹,

Heller

Pieber

et al. 2019

Diabetes Obesity Metabolism

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Aims To evaluate the short‐term cost‐effectiveness of insulin degludec (degludec) vs insulin glargine 100 units/mL (glargine U100) from a Canadian public healthcare payer perspective in patients with type 2 diabetes (T2D) who are at high risk of cardiovascular events and hypoglycaemia. Materials and methods A decision analytic model was developed to estimate costs (2017 Canadian dollars [CAD]) and clinical outcomes (quality‐adjusted life years [QALYs]) with degludec vs glargine U100 over a 2‐year time horizon. The model captured first major adverse cardiovascular event, death, severe hypoglycaemia and insulin dosing. Clinical outcomes were informed by a post hoc subgroup analysis of the DEVOTE trial (NCT01959529), which compared the cardiovascular safety of degludec and glargine U100 in patients with T2D who are at high cardiovascular risk. High hypoglycaemia risk was defined as the top quartile of patients (n = 1887) based on an index of baseline hypoglycaemia risk factors. Results In patients at high hypoglycaemia risk, degludec was associated with mean cost savings (CAD 129 per patient) relative to glargine U100, driven by a lower incidence of non‐fatal myocardial infarction, non‐fatal stroke and severe hypoglycaemia, which offset the slightly higher cost of treatment with degludec. A reduced risk of cardiovascular death and severe hypoglycaemia resulted in improved effectiveness (+0.0132 QALYs) with degludec relative to glargine U100. In sensitivity analyses, changes to the vast majority of model parameters did not materially affect model outcomes. Conclusion Over a 2‐year period, degludec improved clinical outcomes at a lower cost as compared to glargine U100 in patients with T2D at high risk of cardiovascular events and hypoglycaemia.

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Meta-Analysis and Cost-Effectiveness Analysis of Insulin Glargine 100 U/mL Versus Insulin Degludec for the Treatment of Type 2 Diabetes in China

Zhang

et al. 2019

Diabetes Ther

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IntroductionTo evaluate the efficacy and safety as well as the long-term cost-effectiveness of insulin glargine 100 U/mL (IGlar) versus insulin degludec (IDeg) for the treatment of type 2 diabetes mellitus (T2DM) from the Chinese healthcare system perspective.MethodsA systematic search of English and Chinese electronic databases for randomized controlled trials (RCTs) comparing IGlar with IDeg for the treatment of T2DM was performed, followed by a meta-analysis to compare the efficacy and safety of IGlar versus IDeg. The CORE Diabetes Model was used to estimate lifetime costs, quality-adjusted life years (QALYs) gained, and cost-effectiveness of IGlar versus IDeg. One-way and probabilistic sensitivity analyses were conducted to assess the underlying parameter uncertainty.ResultsSix RCTs were included in the meta-analysis. The IGlar group showed a statistically significant decrease in glycated hemoglobin (HbA1c) from baseline compared to the IDeg group (mean difference [MD] 0.08%, 95% confidence interval [CI] 0.01–0.14%, P = 0.02). Body mass index (BMI) control was numerically better in the IGlar group than in the IDeg group (MD 0.07 kg/m2, 95% CI − 0.01 to 0.14 kg/m2, P = 0.08). In terms of hypoglycemia, the incidence of non-severe overall hypoglycemia was comparable between the IDeg and IGlar patient groups (P > 0.05), while the incidence of non-severe nocturnal hypoglycemia (relative risk [RR 0.79], 95% CI 0.70–0.90, P < 0.01) and the event rates of non-severe overall (RR 0.91, 95% CI 0.85–0.97, P < 0.01) and non-severe nocturnal hypoglycemia (RR 0.91, 95% CI 0.85–0.97, P < 0.01) were lower in the IDeg group. The incidences and event rates of both severe overall and nocturnal hypoglycemia were similar for the two groups (P > 0.05). The cost-effectiveness analysis showed that IGlar is the dominant treatment option compared with IDeg, with a lifetime savings of 1004 Chinese yuan in direct medical costs and a net gain of 0.015 QALYs per patient. Both one-way and probabilistic sensitivity analyses confirmed the robustness of the results.ConclusionsIGlar is a cost-saving option with incremental effectiveness compared with IDeg for the treatment of T2DM in China.FundingSanofi China.Electronic Supplementary MaterialThe online version of this article (10.1007/s13300-019-00683-2) contains supplementary material, which is available to authorized users.

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Cost-Effectiveness of Insulin Degludec Versus Insulin Glargine U100 in Patients with Type 1 and Type 2 Diabetes Mellitus in Serbia

Cited by 12 publications

References 50 publications

Cost-effectiveness of insulin degludec versus insulin glargine U100 in adults with type 1 and type 2 diabetes mellitus in Bulgaria

Cost-effectiveness of insulin degludec versus insulin glargine U100 in adults with type 1 and type 2 diabetes mellitus in Bulgaria

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)

Meta-Analysis and Cost-Effectiveness Analysis of Insulin Glargine 100 U/mL Versus Insulin Degludec for the Treatment of Type 2 Diabetes in China

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