Cost-Effectiveness of Insulin Degludec Versus Insulin Glargine U300 in the Netherlands: Evidence From a Randomised Controlled Trial

Marc Evans, Robert G J Moes, Katrine S Pedersen, Jens Gundgaard, Thomas R Pieber, Marc Evans, Robert G J Moes, Katrine S Pedersen, Jens Gundgaard, Thomas R Pieber

Abstract

Introduction: This study aimed to evaluate the short-term cost-effectiveness of insulin degludec 200 units/mL (degludec) versus insulin glargine 300 units/mL (glargine U300) from a Dutch societal perspective.

Methods: A previously published model estimated costs [2018 euros (EUR)] and effectiveness [quality-adjusted life years (QALYs)] with degludec compared with glargine U300 over a 1-year time horizon. The model captured hypoglycaemia rates and insulin dosing. Clinical outcomes were informed by CONCLUDE (NCT03078478), a head-to-head randomised controlled trial in insulin-experienced patients with type 2 diabetes.

Results: Treatment with degludec was associated with mean annual cost savings (EUR 24.71 per patient) relative to glargine U300, driven by a lower basal insulin dose and lower severe hypoglycaemia rate with degludec compared with glargine U300. Lower rates of non-severe nocturnal and severe hypoglycaemia resulted in improved effectiveness (+ 0.0045 QALYs) with degludec relative to glargine U300. In sensitivity analyses, changes to the vast majority of model parameters did not materially affect model outcomes.

Conclusions: This short-term analysis, informed by the latest clinical trial evidence, demonstrated that degludec was a cost-effective treatment option relative to glargine U300. As such, our modelling analysis suggests that degludec would represent an efficient use of Dutch public healthcare resources in this patient population.

Keywords: Diabetes; Health technology assessment; Hypoglycaemia; Insulin analogue; Insulin therapy; Pharmaco-economics.

Figures

Fig. 1
Fig. 1
Cost-effectiveness model schematic. Includes data presented in Tables 1 and 2, in addition to data previously reported [11]. †Assumed to be the same in both simulation arms: one needle and three SMBG tests per day. ‡The model only used significant treatment effects. As the analysis was non-significant for this endpoint, the glargine U300 event rate was assumed in both simulation arms. §Previously reported [11]. Δ difference in, degludec insulin degludec 200 units/mL, EDR estimated dose ratio, ERR estimated rate ratio, EUR euros, glargine U300 insulin glargine 300 units/mL, HRQoL health-related quality of life, ICER incremental cost-effectiveness ratio, QALY quality-adjusted life year, SMBG self-measured blood glucose
Fig. 2
Fig. 2
Probabilistic sensitivity analysis results: a cost-effectiveness scatter plot; b cost-effectiveness acceptability curve. In a, the orange square represents the average value for incremental cost and incremental quality-adjusted life expectancy. EUR euros, degludec insulin degludec 200 units/mL, glargine U300 insulin glargine 300 units/mL, QALY quality-adjusted life year

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