DEVOTE 5: Evaluating the Short-Term Cost-Utility of Insulin Degludec Versus Insulin Glargine U100 in Basal-Bolus Regimens for Type 2 Diabetes in the UK

Richard F Pollock, William J Valentine, Steven P Marso, Jens Gundgaard, Nino Hallén, Lars L Hansen, Deniz Tutkunkardas, John B Buse, DEVOTE Study Group, Richard F Pollock, William J Valentine, Steven P Marso, Jens Gundgaard, Nino Hallén, Lars L Hansen, Deniz Tutkunkardas, John B Buse, DEVOTE Study Group

Abstract

Introduction: The aim of this study was to evaluate the short-term cost-utility of insulin degludec (degludec) versus insulin glargine 100 units/mL (glargine U100) for the treatment of type 2 diabetes in the basal-bolus subgroup of the head-to-head cardiovascular (CV) outcome trial, DEVOTE.

Methods: A cost-utility analysis was conducted over a 2-year time horizon using a decision analytic model to compare costs in patients receiving once daily degludec or glargine U100, both as part of a basal-bolus regimen, in addition to standard care. Clinical outcomes and patient characteristics were taken exclusively from DEVOTE, whilst health-related quality of life utilities and UK-specific costs (expressed in 2016 GBP) were obtained from the literature. The analysis was conducted from the perspective of the National Health Service.

Results: Degludec was associated with mean cost savings of GBP 28.78 per patient relative to glargine U100 in patients with type 2 diabetes at high CV risk. Cost savings were driven by the reduction in risk of diabetes-related complications with degludec, which offset the higher treatment costs relative to glargine U100. Degludec was associated with a mean improvement of 0.0064 quality-adjusted life-years (QALYs) compared with glargine U100, with improvements driven predominantly by lower rates of severe hypoglycemia with degludec versus glargine U100. Improvements in quality-adjusted life expectancy combined with cost neutrality resulted in degludec being dominant over glargine U100. Sensitivity analyses demonstrated that the incremental cost-utility ratio was stable to variations in the majority of model inputs.

Conclusion: The present short-term modeling analysis found that for the basal-bolus subgroup of patients in DEVOTE, with a high risk of CV events, degludec was cost neutral (no additional costs) compared with glargine U100 over a 2-year time horizon in the UK setting. Furthermore, there were QALY gains with degludec, particularly due to the reduction in the risk of severe hypoglycemia.

Funding: Novo Nordisk A/S.

Trial registration: ClinicalTrials.gov identifier, NCT01959529.

Keywords: Cardiovascular outcome trial; Cost; Cost-effective; Diabetes; Hypoglycemia; Insulin degludec; QALY; United Kingdom.

Figures

Fig. 1
Fig. 1
Schematic of the cost-utility model. Diagram shows the model as run for each treatment arm (degludec and glargine U100). The model used relative rates (hazard, rate, and dose ratios) from regression analyses to derive the rates and doses in the degludec arm (see the ”Model Overview” section). * Severe hypoglycemia was defined according to the American Diabetes Association as an episode requiring the assistance of another person to actively administer carbohydrate or glucagon or to take other corrective actions [30]. CV cardiovascular, glargine U100 insulin glargine 100 units/mL, MACE major adverse cardiovascular event, MI myocardial infarction, U units
Fig. 2a–b
Fig. 2a–b
Probabilistic sensitivity analysis results: a cost-utility scatterplot; b cost-utility acceptability curve. In a, the orange square represents the average value for incremental cost and incremental quality-adjusted life expectancy. GBP pounds sterling, glargine U100 insulin glargine 100 units/mL, QALY quality-adjusted life-years

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