Cost-Effectiveness of Insulin Degludec vs. Insulin Glargine U100 in Type 1 and Type 2 Diabetes Mellitus in a UK Setting

Marc Evans, Roopa Mehta, Jens Gundgaard, Barrie Chubb, Marc Evans, Roopa Mehta, Jens Gundgaard, Barrie Chubb

Abstract

Background: Understanding which therapeutic innovations in diabetes represent the best value requires rigorous economic evaluation. Data from randomised controlled trials and observational studies indicate that insulin degludec has a hypoglycemia advantage versus insulin glargine 100 units/mL (glargine U100), the most widely prescribed basal insulin analogue in the UK. This analysis was done to more rigorously assess cost-effectiveness in a UK setting.

Methods: Data from two double-blinded, randomised, two-period crossover trials in type 1 (SWITCH 1) and type 2 (SWITCH 2) diabetes mellitus were used to assess the cost-effectiveness of degludec vs. glargine U100 with an economic model. Cost-effectiveness was analysed over a 1-year time horizon based on the different rates of hypoglycaemia and actual doses of insulin used, rather than glycaemic control due to the treat-to-target trial design.

Results: In type 1 diabetes mellitus, degludec was highly cost-effective compared with glargine U100, with an incremental cost-effectiveness ratio of £984 (increased costs of only £23/year and improvement in participant health of 0.0232 quality-adjusted life-years (QALYs)). In type 2 diabetes mellitus, it was estimated that quality of life was improved (0.0065 QALYs gain) with degludec compared with glargine U100 at an increased annual cost of £117 (incremental cost-effectiveness ratio, £17,939). One-way sensitivity analyses showed that the results were robust to changes in parameters in both type 1 and type 2 diabetes mellitus.

Conclusions: The rigorous design of the SWITCH trials, coupled with a representative patient population and a definition of hypoglycaemia that is relevant for real-world patients, makes the results of these trials highly generalisable. The within-trial analysis has the added value of being able to include doses and event rates directly from the trials. This short-term economic analysis estimated that IDeg would be cost-effective relative to IGlar U100 in both type 1 and type 2 diabetes mellitus in the UK.

Trial registration: SWITCH 1 (NCT02034513); SWITCH 2 (NCT02030600).

Funding: Novo Nordisk, Søborg, Denmark.

Keywords: Cost-effectiveness; Diabetes; Hypoglycaemia; Insulin degludec; Insulin glargine; Pharmacoeconomics; Type 1 diabetes; Type 2 diabetes.

Figures

Fig. 1
Fig. 1
Cost-effectiveness modelling of degludec. Reprinted with the permission of the publisher (Taylor & Francis Ltd, http://www.tandfonline.com) [12]. HRQoL health-related quality of life, hypo hypoglycaemia, ICER incremental cost-effectiveness ratio, IDeg insulin degludec, IGlar insulin glargine U100, QALY quality-adjusted life-year

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Source: PubMed

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