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)

Richard F Pollock, Simon Heller, Thomas R Pieber, Vincent Woo, Jens Gundgaard, Nino Hallén, Maria Luckevich, Deniz Tutkunkardas, Bernard Zinman, DEVOTE Study Group, Richard F Pollock, Simon Heller, Thomas R Pieber, Vincent Woo, Jens Gundgaard, Nino Hallén, Maria Luckevich, Deniz Tutkunkardas, Bernard Zinman, DEVOTE Study Group

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.

Keywords: cost-effectiveness; insulin analogues; insulin therapy; pharmaco-economics.

Conflict of interest statement

R. F. P is a full‐time employee of Ossian Health Economics and Communications GmbH, which received consultancy fees from Novo Nordisk to construct the model and to conduct the analyses. S. H. reports consultancy fees from Eli Lilly and Co., Novo Nordisk and Takeda; has participated in speakers' bureaus for Novo Nordisk, Eli Lilly and Co, Merck Sharp and Dohme, Takeda and AstraZeneca; and has served on advisory panels for Novo Nordisk, Eli Lilly and Co., Boeringher Ingelheim, Sanofi Aventis, Zealand Pharma and UN‐EEG. T. R. P. is an employee of CBmed; he reports consultancy fees from Arecor, AstraZeneca, Eli Lilly and Co., Novo Nordisk and Sanofi and has received research support from Novo Nordisk and AstraZeneca. V. W. has served on advisory boards and speakers' bureaus for Novo Nordisk, Eli Lilly and Co., Merck Sharp and Dohme, Boehringer Ingelheim, BMS, Sanofi, AstraZeneca, Johnson and Johnson, Roche and Abbott. J. G., N. H., M. L. and D.T. are employees of Novo Nordisk; and D. T. and J. G. hold shares/stocks in Novo Nordisk. B. Z. has received consultancy fees from Novo Nordisk, Boehringer Ingelheim, AstraZeneca, Eli Lilly and Co., Janssen, Sanofi, Merck and Abbott.

© 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Probabilistic sensitivity analysis results: (A) cost‐utility scatterplot; (B) cost‐utility acceptability curve. (A), orange square represents the average value for incremental cost and incremental quality‐adjusted life expectancy. Abbreviations: CAD, Canadian dollars; glargine U100; insulin glargine 100 units/mL; QALY, quality‐adjusted life years

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