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)

Abstract

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.

Cost‐Effectiveness of Pharmacist‐Led Deprescribing ofNSAIDsin Community‐Dwelling Older Adults

“…Disutilities were subtracted from the baseline utility to generate utility corresponding to states modeled. We derived utility and disutility values from the published literature that corresponds to our study population and model structure (Table ) . For each cycle, the proportion of patients in each state was multiplied by the corresponding utility value to estimate cycle‐specific quality‐adjusted life‐years (QALYs).…”

“…Baseline utility and disutilities associated with adverse outcomes were derived from published studies. Utility weights were generated using the validated multidimensional EQ‐5D scale that measures general health status . EQ‐5D is composed of five attributes: mobility, self‐care, usual activities, pain/discomfort, and anxiety/depression.…”

Basal Insulinotherapy in Patients Living with Diabetes in France: The EF-BI Study

“…Secondly, as a result of the need for sufficient observation time in the analyses, and to the relatively recent marketing of other basal insulins, the number of patients available did not allow us to make other comparisons than between BI Gla-300 and Gla-100. Several articles have been published showing acceptability of the incremental cost-effectiveness ratio or dominance of insulin degludec 100 U/mL (IDeg-100) as compared to Gla-100 or insulin detemir [22][23][24][25][26][27]. Evidence was also provided in Sweden through a prospective observational study using real-world data [12].…”