Cost–effectiveness of insulin detemir: a systematic review

Suh, Dong‐Churl; Aagren, Mark

doi:10.1586/erp.11.73

Cited by 8 publications

(6 citation statements)

References 66 publications

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“…There are also no other published data that directly compare degludec and NPH. However, a systematic review of 15 modelling studies found that another basal insulin analogue, insulin detemir, was cost-effective vs. NPH and at least as cost-effective as glargine U100 in both type 1 and type 2 diabetes mellitus [ 29 ]. Data from the UK have also shown that insulin detemir was cost-effective vs. NPH in type 1 diabetes mellitus [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Insulin Degludec vs. Insulin Glargine U100 in Type 1 and Type 2 Diabetes Mellitus in a UK Setting

et al. 2018

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BackgroundUnderstanding which therapeutic innovations in diabetes represent the best value requires rigorous economic evaluation. Data from randomised controlled trials and observational studies indicate that insulin degludec has a hypoglycemia advantage versus insulin glargine 100 units/mL (glargine U100), the most widely prescribed basal insulin analogue in the UK. This analysis was done to more rigorously assess cost-effectiveness in a UK setting.MethodsData from two double-blinded, randomised, two-period crossover trials in type 1 (SWITCH 1) and type 2 (SWITCH 2) diabetes mellitus were used to assess the cost-effectiveness of degludec vs. glargine U100 with an economic model. Cost-effectiveness was analysed over a 1-year time horizon based on the different rates of hypoglycaemia and actual doses of insulin used, rather than glycaemic control due to the treat-to-target trial design.ResultsIn type 1 diabetes mellitus, degludec was highly cost-effective compared with glargine U100, with an incremental cost-effectiveness ratio of £984 (increased costs of only £23/year and improvement in participant health of 0.0232 quality-adjusted life-years (QALYs)). In type 2 diabetes mellitus, it was estimated that quality of life was improved (0.0065 QALYs gain) with degludec compared with glargine U100 at an increased annual cost of £117 (incremental cost-effectiveness ratio, £17,939). One-way sensitivity analyses showed that the results were robust to changes in parameters in both type 1 and type 2 diabetes mellitus.ConclusionsThe rigorous design of the SWITCH trials, coupled with a representative patient population and a definition of hypoglycaemia that is relevant for real-world patients, makes the results of these trials highly generalisable. The within-trial analysis has the added value of being able to include doses and event rates directly from the trials. This short-term economic analysis estimated that IDeg would be cost-effective relative to IGlar U100 in both type 1 and type 2 diabetes mellitus in the UK.Trial RegistrationSWITCH 1 (NCT02034513); SWITCH 2 (NCT02030600).FundingNovo Nordisk, Søborg, Denmark.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0478-1) contains supplementary material, which is available to authorised users.

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Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Insulin Degludec vs. Insulin Glargine U100 in Type 1 and Type 2 Diabetes Mellitus in a UK Setting

et al. 2018

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“…In the case of the albumin binding insulin detemir the modification is purely chemical, and only a single step so the infrastructure for scale-up of this product is already present in the industry. Because of the simplicity the cost-effectiveness is comparable to the recombinant basal insulin glargine [104]. This methodology has worked well for three peptides in diabetes so conceivably the methodology could be expanded into controlled release of peptides for other indications.…”

Section: Concluding Remarks and Future Directionsmentioning

confidence: 99%

Fatty acids as therapeutic auxiliaries for oral and parenteral formulations

Hackett

Zaro

Shen

et al. 2013

Advanced Drug Delivery Reviews

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Many drugs have decreased therapeutic activity due to issues with absorption, distribution, metabolism and excretion. The co-formulation or covalent attachment of drugs with fatty acids has demonstrated some capacity to overcome these issues by improving intestinal permeability, slowing clearance and binding serum proteins for selective tissue uptake and metabolism. For orally administered drugs, albeit at low level of availability, the presence of fatty acids and triglycerides in the intestinal lumen may promote intestinal uptake of small hydrophilic molecules. Small lipophilic drugs or acylated hydrophilic drugs also show increased lymphatic uptake and enhanced passive diffusional uptake. Fatty acid conjugation of small and large proteins or peptides have exhibited protracted plasma half-lives, site-specific delivery and sustained release upon parenteral administration. These improvements are most likely due to associations with lipid-binding serum proteins, namely albumin, LDL and HDL. These molecular interactions, although not fully characterized, could provide the ability of using the endogenous carrier systems for improving therapeutic outcomes.

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“…In addition, the pharmacokinetics of NPH may result in nocturnal hypoglycaemia that can also lead to fasting hyperglycemia in the morning. Besides improved glycaemic control and a lower risk of hypoglycaemia, detemir and glargine have also been shown to be associated with improved quality of life and higher treatment satisfaction compared with NPH .…”

Section: Development Of Protracted Acting Insulin and Insulin Analoguesmentioning

confidence: 99%

Basal insulin analogues in the management of diabetes mellitus: what progress have we made?

Owens

Matfin²,

Monnier³

2014

Diabetes Metabolism Res

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Insulin remains the most effective and consistent means of controlling blood glucose levels in diabetes. Since 1946, neutral protamine Hagedorn (NPH) has been the predominant basal insulin in clinical use. However, absorption is variable due to the need for resuspension and the time-action profile (peak activity 4-6 h after subcutaneous administration) confers an increased propensity for between-meal and nocturnal hypoglycaemia. In the 1980s, recombinant DNA technology enabled modifications to the insulin molecule resulting in the soluble long-acting insulin analogues, glargine and detemir. Both exhibit a lower risk of hypoglycaemia compared with neutral protamine Hagedorn due to improved time-action profiles and reduced day-to-day glucose variability. Glargine is indicated for administration once daily and detemir once or twice daily. Degludec is the latest prolonged-acting insulin which forms long subcutaneous multi-hexamers that delay absorption. Recent phase III trials in type 1 and type 2 diabetes show that degludec was non-inferior to comparators (predominantly glargine) with a minimal although inconsistent reduction in overall hypoglycaemia and a small absolute difference in nocturnal hypoglycaemia. Newer developmental agents include LY2605541 and glargine U300. LY2605541 comprises insulin lispro combined with polyethylene glycol, thereby increasing its hydrodynamic size and retarding absorption from the subcutaneous tissue. Glargine U300 is a new formulation of glargine resulting in a flatter and more prolonged time-action profile than its predecessor. This article reviews recent advances in basal insulin analogues, including a critical appraisal of the degludec trials.

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Cost–effectiveness of insulin detemir: a systematic review

Cited by 8 publications

References 66 publications

Cost-Effectiveness of Insulin Degludec vs. Insulin Glargine U100 in Type 1 and Type 2 Diabetes Mellitus in a UK Setting

Cost-Effectiveness of Insulin Degludec vs. Insulin Glargine U100 in Type 1 and Type 2 Diabetes Mellitus in a UK Setting

Fatty acids as therapeutic auxiliaries for oral and parenteral formulations

Basal insulin analogues in the management of diabetes mellitus: what progress have we made?

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