Evaluation of the Short-Term Cost-Effectiveness of IDegLira Versus Continued Up-Titration of Insulin Glargine U100 in Patients with Type 2 Diabetes in the USA

Abstract

IntroductionEffective glycemic control can reduce the risk of complications and their related costs in type 2 diabetes mellitus (T2DM). However, many patients fail to reach glycemic targets, often because of adverse effects of treatment (including hypoglycemia or weight gain). The present analysis evaluated the short-term cost-effectiveness of IDegLira versus continued up-titration of insulin glargine U100 in patients with T2DM failing to achieve glycemic control on basal insulin in the US setting.MethodsThe cost per patient achieving treatment target (cost of control) was assessed for various single and composite endpoints for the entire trial population and in patients with baseline glycated hemoglobin (HbA1c) >8.0% and HbA1c >9.0%. The proportions of patients achieving treatment targets were analyzed using data obtained in the DUAL V study. Costs were accounted based on published wholesale acquisition costs.ResultsWhen assessing the full trial population, IDegLira was associated with lower annual cost of control than continued up-titration of insulin glargine U100 for patients achieving HbA1c ≤6.5% without confirmed hypoglycemia (by $10,608), HbA1c ≤6.5% without weight gain (by $29,215), and HbA1c ≤6.5% without confirmed hypoglycemia and weight gain (by $57,351). A similar pattern was observed when multifactorial treatment targets were based on achieving a glycemic target of 7.0%. When only HbA1c was considered, IDegLira was associated with a lower cost per patient achieving HbA1c ≤6.5% (by $3306) but cost of control was equivalent for a target of HbA1c <7.0%. In patients with baseline HbA1c >8.0% and HbA1c >9.0%, IDegLira was associated with a lower cost of control for all treatment targets.ConclusionThe significantly greater clinical efficacy in terms of bringing patients to treatment targets identified in the DUAL V study results in lower cost of control values for IDegLira versus continued up-titration of insulin glargine U100 in the USA. This suggests IDegLira is a cost-effective treatment option in the USA.FundingNovo Nordisk A/S and Novo Nordisk Inc.

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

“…In clinical practice, therapy intensification for this group of patients would typically be basal insulin initiation; however, our results indicate that addition of IDegLira is a superior treatment option. Furthermore, a previous cost‐effectiveness analysis identified that treatment with IDegLira versus continued uptitration of IGlar U100 demonstrates a lower cost per patient achieving treatment targets . Weight gain and hypoglycaemia are well‐known barriers for insulin initiation for both patients and healthcare providers, therefore IDegLira should be considered at the point of insulin initiation, as patients will have the potential benefits of superior glycaemic control, with lower weight gain and a lower risk of hypoglycaemia, as well as lower perceived treatment burden and easier diabetes management, which could improve treatment compliance and satisfaction .…”

Initiating therapy in patients newly diagnosed with type 2 diabetes: Combination therapy vs a stepwise approach

“…This study assessed the cost per patient achieving treatment target (cost of control) for various single and composite endpoints for the entire trial population and in patients with baseline HbA1c >8.0% and HbA1c >9.0%. In this study, the significantly greater clinical efficacy of the FRC resulted in lower cost of control values vs continued uptitration of insulin glargine …”

Clinical Considerations When Initiating and Titrating Insulin Degludec/Liraglutide (IDegLira) in People with Type 2 Diabetes

“…The cost effectiveness of treatment interventions is a key consideration when choosing therapies for people with T2D. Direct comparison of the acquisition costs of different therapies is insufficient to inform healthcare payer decision making as there are multiple factors to consider aside from achieving glycemic control, including the likelihood and burden of adverse events such as hypoglycemia and body weight gain, quality of life, and, importantly, the prognosis for diabetes-related micro-and macrovascular complications [74][75][76].…”

“…Short-and long-term cost-effectiveness analyses of IDe-gLira in comparison with uptitration of IGlar U100 and basal-bolus therapy of IGlar U100 and IAsp, have been conducted [74][75][76][77][78][79]. Based on clinical trial data from both the US and the UK, IDegLira has been shown to provide a cost-effective treatment option in people with uncontrolled T2D (Table 3) [74][75][76][77][78][79]. In the analyses where IDegLira was associated with increased costs, incremental costeffectiveness ratios remained well below the US valuebased price benchmark of $100,000-$150,000 per qualityadjusted life-year (QALY) gained suggested by the Institute for Clinical and Economic Review, or the commonly accepted willingness-to-pay threshold of £20,000-£30,000/ QALY in the UK ( Table 3).…”

“…In the analyses where IDegLira was associated with increased costs, incremental costeffectiveness ratios remained well below the US valuebased price benchmark of $100,000-$150,000 per qualityadjusted life-year (QALY) gained suggested by the Institute for Clinical and Economic Review, or the commonly accepted willingness-to-pay threshold of £20,000-£30,000/ QALY in the UK ( Table 3). The short-term cost of control analyses (cost per person achieving treatment targets) have reported lower or equivalent annual costs of control with IDegLira in comparison with basal-bolus therapy or basal insulin uptitration, both for glycemic targets (HbA 1c ≤ 6.5% [≤ 48 mmol/mol] or < 7.0% [< 53 mmol/mol]) singularly and for composite endpoints without hypoglycemia and/or body weight gain [75,79]. For example, in an analysis of the full DUAL V trial population, the annual cost per participant achieving a target of HbA 1c ≤ 6.5% (48 mmol/mol) was lower with IDegLira than with continued uptitration of IGlar U100 ($18,556 compared with $21,862); however, the cost per participant achieving HbA 1c < 7.0% (53 mmol/ mol) was similar in the two arms ($14,358 compared with $14,327) [75].…”