Cost-Effectiveness of Insulin Degludec/Insulin Aspart Versus Biphasic Insulin Aspart in Patients with Type 2 Diabetes from a Danish Health-Care Perspective

Marc Evans, Jens Gundgaard, Brian Bekker Hansen, Marc Evans, Jens Gundgaard, Brian Bekker Hansen

Abstract

Introduction: To evaluate the cost-effectiveness of the co-formulation insulin degludec/insulin aspart (IDegAsp) versus biphasic insulin aspart (BIAsp 30), both administered twice daily, in patients with type 2 diabetes mellitus (T2DM), using a short-term cost-effectiveness model.

Methods: Data from two phase 3a treat-to-target clinical trials were used to populate a simple and transparent short-term cost-effectiveness model. The costs and effects of treatment with IDegAsp versus BIAsp 30 were calculated over a 5-year period, from a Danish health-care cost perspective. One-way and probabilistic sensitivity analyses were conducted to assess the degree of uncertainty and robustness of the results.

Results: The base-case incremental cost-effectiveness ratio (ICER) of 81,507.91 Danish Kroner (DKK) per quality-adjusted life year (QALY) demonstrates that IDegAsp is a cost-effective treatment compared with BIAsp 30, over a 5-year time horizon. One-way sensitivity analyses show that the ICERs remain within an acceptable range when the rates of hypoglycemia, unit cost of hypoglycemia, disutilities of hypoglycemic events, and the time horizon are varied, ranging from 71,012 DKK to 209,446 DKK. The probabilistic sensitivity analysis demonstrates that the probability that IDegAsp is cost-effective relative to BIAsp 30 is 99.50%, assuming a cost-effectiveness threshold of 250,000 DKK per QALY.

Conclusion: This short-term cost-effectiveness model shows that IDegAsp is a cost-effective treatment compared with BIAsp 30 for patients with T2DM. This result is primarily driven by significant reductions in severe hypoglycemia and insulin dose observed with IDegAsp versus BIAsp 30. Sensitivity analyses demonstrate the robustness of these results.

Funding: Novo Nordisk A/S, Søborg, Denmark.

Keywords: Cost-effectiveness; Insulin analogs; Pharmacoeconomics; Type 2 diabetes mellitus.

Figures

Fig. 1
Fig. 1
Structure of the cost-effectiveness model. The model captured treatment costs (including insulin, needles, and costs associated with SMBG testing) and costs associated with hypoglycemic events (the resource used to treat the event multiplied by the hypoglycemic event rate) for both IDegAsp and comparator. QALYs were calculated by applying disutilities (reduction in HRQoL) per hypoglycemic event, SMBG test, and BMI gain. BIAsp 30 biphasic insulin aspart, BMI body mass index, HC health care, HRQoL health-related quality of life, ICER incremental cost-effectiveness ratio, IDegAsp insulin degludec/insulin aspart, QALY quality-adjusted life year, SMBG self-measured blood glucose

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