IDegLira Versus Insulin Glargine U100: A Long-term Cost-effectiveness Analysis in the US Setting

Abstract

IntroductionTreatment with IDegLira has the potential to improve glycemic control in patients with type 2 diabetes mellitus (T2DM) without the weight gain and with a lower risk of hypoglycemia than with other therapies. The aim of the present analysis was to evaluate the long-term cost-effectiveness of IDegLira versus insulin glargine U100 with re-education and up-titration of the dose for treatment of patients with T2DM failing to achieve glycemic control on basal insulin in the US setting.MethodsData were obtained from the DUAL V randomized controlled trial in which adults with T2DM failing to achieve glycemic targets with insulin glargine U100 were randomly allocated to receive either IDegLira or insulin glargine U100. Long-term projections of clinical outcomes and direct costs were made using the IMS CORE Diabetes Model. Costs were accounted from a healthcare payer perspective. Future costs and clinical benefits were discounted at 3% annually.ResultsIDegLira was associated with improved discounted life expectancy (13.99 [standard deviation 0.19] versus 13.82 [standard deviation 0.20] years) and quality-adjusted life expectancy (9.14 [standard deviation 0.12] versus 8.87 [standard deviation 0.13] quality-adjusted life years [QALYs]) compared to insulin glargine U100. IDegLira was associated with increased direct costs of $16,970, yielding an incremental cost-effectiveness ratio (ICER) of $63,678 per QALY gained versus insulin glargine U100. Sensitivity analyses identified that the key driver of cost-effectiveness was the greater reduction in glycated hemoglobin with IDegLira compared with insulin glargine U100.ConclusionsBased on head-to-head clinical trial data, the present analysis suggests that IDegLira is likely to improve long-term clinical outcomes for patients with T2DM not achieving glycemic control on basal insulin compared to re-education and up-titration of the dose of insulin glargine U100, with these improvements coming at an increased cost from a healthcare payer perspective. An ICER within the range described as high care value was calculated, suggesting IDegLira is a cost-effective treatment option in the US. Funding: Novo Nordisk A/S and Novo Nordisk Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0251-x) 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.…”

The management of type 2 diabetes with fixed‐ratio combination insulin degludec/liraglutide (IDegLira) versus basal‐bolus therapy (insulin glargine U100 plus insulin aspart): A short‐term cost‐effectiveness analysis in the UK setting

“…13,24 There is no current uniform national or international consensus for the optimal treatment regimen in type 2 diabetes, including the intensification steps beyond monotherapy, the ideal combination when basal insulin is introduced, and the In contrast with long-term models of type 2 diabetes, rates of complications were not included, as they were not expected to vary over the short-term time horizon of the analysis. [44][45][46] Furthermore, glycaemic control, a key driver of rates of diabetes-related complications, was equivalent in both arms. However, rates of diabetes-related complications can also be influenced by blood pressure, BMI and serum lipid levels, and IDegLira was associated with improvements in all of these risk factors versus BBT in the DUAL VII trial.…”

“…In contrast with long‐term models of type 2 diabetes, rates of complications were not included, as they were not expected to vary over the short‐term time horizon of the analysis 44, 45, 46. Furthermore, glycaemic control, a key driver of rates of diabetes‐related complications, was equivalent in both arms.…”

“…However, it is common practice to adapt clinical trial data from multinational cohorts to country‐specific analyses, with this methodology found throughout the published literature 45, 46, 50, 51, 52. Moreover, the effect of IDegLira and BBT would not be expected to vary across the different country settings included in the DUAL VII trial and the UK.…”

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].…”