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

Abstract

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.

Current utilization patterns for long-acting insulin analogues including biosimilars among selected Asian countries and the implications for the future

“…Global sales of insulin detemir were US$2.7 billion in 2015 and growing at 7.5% per year (38), with global sales of insulin degludec rising 1.8 fold to US$1.11 billion in 2017 versus 2016 (39). Growing sales of insulin detemir and degludec are enhanced by studies suggesting improved cost-effectiveness versus insulin glargine; however, this is not always the case (40)(41)(42)(43)(44).…”

Safety and efficacy of long-acting insulins (degludec and glargine) among type 2 diabetic Asian Population: A Systematic Review and Meta-Analysis

“…[14] There are conflicting results in earlier studies like a meta-analysis by Su W et al, found Glargine was to be superior to degludec. [15] Contrary to this, meta-analysis by Zhou W et al, found degludec much better than glargine. [16] In view of the conflicting data regarding efficacy, it is necessary to compare and prioritize the treatment so far as long-acting insulin use is concerned.…”

Efficacy and Safety of a Decision Support Intervention for Basal Insulin Self-Titration Assisted by the Nurse in Outpatients with T2DM: A Randomized Controlled Trial

“… 7 U-100 glargine, the first long-acting insulin analog approved in China, reduces the risk of symptomatic and nocturnal hypoglycemia to a greater extent than NPH insulin in real-life studies from our country. 6 , 8 Glargine has been widely used in China for treatment of T2DM, with cost-saving advantage 9 and acceptable side-effects, such as slight weight gain and low hypoglycemia risk. 9 , 10 However, several critical barriers to BI therapy pose a challenge, including suboptimal dose titration and fear of hypoglycemia.…”

“…6,8 Glargine has been widely used in China for treatment of T2DM, with cost-saving advantage 9 and acceptable side-effects, such as slight weight gain and low hypoglycemia risk. 9,10 However, several critical barriers to BI therapy pose a challenge, including suboptimal dose titration and fear of hypoglycemia.…”