Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

Abstract

Introduction Few patients with type 2 diabetes mellitus (T2DM) achieve recommended glycemic control targets in the Czech Republic. Novel therapies, such as fixed-ratio combinations of basal insulin plus glucagon-like peptide-1 receptor agonists, may contribute to better glycemic control. In the analysis presented here, the present analysis assessed the long-term cost-effectiveness of two fixed-ratio combinations, IDegLira (insulin degludec/liraglutide) and iGlarLixi (insulin glargine/lixisenatide), for the treatment of patients with T2DM inadequately controlled with basal insulin from a healthcare payer perspective in the Czech Republic. Methods A cost-effectiveness analysis was performed over patient lifetimes using the IQVIA CORE Diabetes Model. Treatment effects were obtained from an indirect treatment comparison as no head-to-head data for IDegLira versus iGlarLixi are currently available. IDegLira was compared with two iGlarLixi pens (100 U/mL insulin glargine + 33 μg/mL and 50 μg/mL of lixisenatide, respectively). Direct medical costs associated with pharmaceutical interventions, screening and diabetes-related complications were captured. Deterministic and probabilistic sensitivity analyses were performed. Results IDegLira was associated with gains in life expectancy of 0.11 years and in quality-adjusted life expectancy of 0.14 quality-adjusted life-years (QALYs) versus iGlarLixi, due to a lower cumulative incidence and delayed onset of diabetes-related complications. IDegLira was also associated with higher projected costs due to higher acquisition costs; however, these were partially offset by cost savings from avoided complications. IDegLira was associated with incremental cost-effectiveness ratios of Czech Koruna (CZK) 695,998 and CZK 348,323 per QALY gained versus iGlarLixi pens containing 33 and 50 μg/mL of lixisenatide, respectively. These ratios were below the commonly used willingness-to-pay threshold of CZK 1,200,000 per QALY gained. Conclusion The present analysis indicated that IDegLira was associated with clinical benefits relative to iGlarLixi over patient lifetimes and was likely to be cost-effective in the treatment of patients with T2DM uncontrolled on basal insulin in the Czech Republic. Funding Novo Nordisk. Plain Language Summary Plain language summary is available for this article. Electronic Supplementary Material The online version of this article (10.1007/s13300-019-0569-7) contains supplementary material, which is available to authorized users.

<p>Value For Money In The Treatment Of Patients With Type 2 Diabetes Mellitus: Assessing The Long-Term Cost-Effectiveness Of IDegLira Versus iGlarLixi In Italy</p>

“…To date, one other cost-effectiveness analysis comparing IDegLira with iGlarLixi has been published. This analysis in the Czech Republic produced similar outcomes to the present analysis in Italy 41. IDegLira was associated with improved clinical outcomes and increased costs compared with iGlarLixi, but was likely to be considered cost-effective in the Czech Republic.…”

Cost-Effectiveness of iGlarLixi in People with Type 2 Diabetes Mellitus Suboptimally Controlled on Basal Insulin Plus Metformin in the UK

“…Previous publications have reported on cost-effectiveness estimates for iDegLira versus iGlarLixi from Italian and Czech Republic perspectives. In the Italian estimate, iDegLira was associated with an incremental cost of €930 and a gain of 0.13 QALYs [ 31 ], while in the Czech Republic the incremental cost was estimated to be CZK 94,029 (£3164) for the iGlarLixi 100/33 (30–60) pen and CZK 47,058 (£1583) for the iGlarLixi 100/50 (10–40) pen, with a gain of 0.14 QALYs [ 32 ]. These cost estimates are qualitatively different from those presented in this UK analysis, which consistently demonstrated iGlarLixi to be less expensive than comparators, but in both analyses, the ICER estimates for iDegLira were well below local WTP thresholds.…”

Titratable fixed-ratio combination of insulin glargine plus lixisenatide: A simplified approach to glycemic control in type 2 diabetes mellitus

“…In this analysis, iDegLira was associated with a greater reduction in HbA1c and body weight and a lower risk of severe hypoglycemia; however, using the ADA definition of symptomatic hypoglycemia for both studies, no significant difference was observed between treatments [51]. Moreover, other analyses have recently found iDegLira to be costeffective compared to iGlarLixi in patients with uncontrolled T2DM on BI due to reduced incidence and delayed onset of complications [52,53].…”