Cost Effectiveness of Once-Weekly Semaglutide Versus Once-Weekly Dulaglutide in the Treatment of Type 2 Diabetes in Canada

Pierre Johansen, Jonas Håkan-Bloch, Aiden R Liu, Peter G Bech, Sofie Persson, Lawrence A Leiter, Pierre Johansen, Jonas Håkan-Bloch, Aiden R Liu, Peter G Bech, Sofie Persson, Lawrence A Leiter

Abstract

Objective: The aim of this study was to assess the cost effectiveness of semaglutide versus dulaglutide, as an add-on to metformin monotherapy, for the treatment of type 2 diabetes (T2D), from a Canadian societal perspective.

Methods: The Swedish Institute for Health Economics Cohort Model of T2D was used to assess the cost effectiveness of once-weekly semaglutide (0.5 or 1.0 mg) versus once-weekly dulaglutide (0.75 or 1.5 mg) over a 40-year time horizon. Using data from the SUSTAIN 7 trial, which demonstrated comparatively greater reductions in glycated hemoglobin (HbA1c), body mass index and systolic blood pressure with semaglutide, compared with dulaglutide, a deterministic base-case and scenario simulation were conducted. The robustness of the results was evaluated with probabilistic sensitivity analyses and 15 deterministic sensitivity analyses.

Results: The base-case analysis indicated that semaglutide is a dominant treatment option, compared with dulaglutide. Semaglutide was associated with lower total costs (Canadian dollars [CAN$]) versus dulaglutide for both low-dose (CAN$113,287 vs. CAN$113,690; cost-saving: CAN$403) and high-dose (CAN$112,983 vs. CAN$113,695; cost-saving: CAN$711) comparisons. Semaglutide resulted in increased quality-adjusted life-years (QALYs) and QALY gains, compared with dulaglutide, for both low-dose (11.10 vs. 11.07 QALYs; + 0.04 QALYs) and high-dose (11.12 vs. 11.07 QALYs; + 0.05 QALYs) comparisons. The probabilistic sensitivity analysis showed that for 66-73% of iterations, semaglutide was either dominant or was considered cost effective at a willingness-to-pay threshold of CAN$50,000.

Conclusions: From a Canadian societal perspective, semaglutide may be a cost-effective treatment option versus dulaglutide in patients with T2D who are inadequately controlled on metformin monotherapy.

Conflict of interest statement

Pierre Johansen, Aiden R. Liu and Peter Bech are employees of Novo Nordisk. Pierre Johansen was employed by the Swedish IHE prior to the time of this study. Jonas Håkan-Bloch was employed by Novo Nordisk at the time this study was conducted. Sofie Persson is employed by IHE, which received grant funding from Novo Nordisk. Lawrence A. Leiter received no payment or services related to this study, but has received research support from AstraZeneca, Boehringer Ingelheim, Eli Lilly, GSK, Janssen, Merck, Novo Nordisk and Sanofi, and has been on advisory panels and provided continuing medical education for AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novo Nordisk, Sanofi and Servier.

Figures

Fig. 1
Fig. 1
The IHE cohort model of T2D. CHF congestive heart failure, IHD ischemic heart disease, IHE Swedish Institute of Health Economics, MI myocardial infarction, T2D type 2 diabetes
Fig. 2
Fig. 2
Base-case progression over time in a HbA1c, b SBP, and c BMI for the low-dose comparison, and in d HbA1c, e SBP, and f BMI for the high-dose comparison. Scenario progression over time in g HbA1c, h SBP, and i BMI for the low-dose comparison, and in j HbA1c, k SBP, and l BMI for the high-dose comparison. BMI body mass index, HbA1c glycated hemoglobin, SBP systolic blood pressure
Fig. 3
Fig. 3
CEP based on incremental costs and QALYs in the base-case analysis for the a low-dose and b high-dose comparison, and in the scenario analysis for the c low-dose and d high-dose comparison. a In the semaglutide 0.5 mg vs. dulaglutide 0.75 mg comparison, at a WTP threshold of CAN$50,000, 66% of ICERs were cost effective. b In the semaglutide 1.0 mg vs. dulaglutide 1.5 mg comparison, at a WTP threshold of CAN$50,000, 73% of ICERs were cost effective. c In the semaglutide 0.5 mg vs. dulaglutide 0.75 mg comparison, at a WTP threshold of CAN$50,000, 98% of ICERs were cost effective. d In the semaglutide 1.0 mg vs. dulaglutide 1.5 mg comparison, at a WTP threshold of CAN$50,000, 98% of ICERs were cost effective. CAN$ Canadian dollars, CEP cost-effectiveness plane, ICER incremental cost-effectiveness ratio, QALY quality-adjusted life-year, WTP willingness to pay

References

    1. International Diabetes Federation. Canada Country Report 2017 & 2045. IDF Diabetes Atlas, 8th ed. Brussels: International Diabetes Federation; 2017. . Accessed Oct 2018.
    1. International Diabetes Federation. IDF Diabetes Atlas, 7th ed. Brussels. International Diabetes Federation; 2017. . Accessed June 2018.
    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127(1):143–152.
    1. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2013;37:S1–S212.
    1. Somerville R. An economic tsunami: the cost of diabetes in Canada. Toronto: Canadian Diabetes Association; 2009. . Accessed Oct 2018.
    1. O’Brien JA, Patrick AR, Caro JJ. Cost of managing complications resulting from type 2 diabetes mellitus in Canada. BMC Health Serv Res. 2003;3(1):7.
    1. American Diabetes Association Guidelines for computer modeling of diabetes and its complications. Diabetes Care. 2004;27(9):2262–2265.
    1. Govan L, Wu O, Lindsay R, Briggs A. How do diabetes models measure up? A review of diabetes economic models and ADA guidelines. J Health Econ Outcomes Res. 2015;3(2):132–152.
    1. McEwan P, Foos V, Palmer JL, Lamotte M, Lloyd A, Grant D. Validation of the IMS CORE diabetes model. Value Health. 2014;17(6):714–724.
    1. Palmer AJ, Roze S, Valentine WJ, Minshall ME, Foos V, Lurati FM, et al. The CORE diabetes model: projecting long-term clinical outcomes, costs and cost-effectiveness of interventions in diabetes mellitus (types 1 and 2) to support clinical and reimbursement decision-making. Curr Med Res Opin. 2004;20(Suppl 1):S5–S26.
    1. Willis M, Johansen P, Nilsson A, Asseburg C. Validation of the economic and health outcomes model of type 2 diabetes mellitus (ECHO-T2DM) Pharmacoeconomics. 2017;35(3):375–396.
    1. Willis M, Asseburg C, He J. Validation of economic and health outcomes simulation model of type 2 diabetes mellitus (ECHO-T2DM) J Med Econ. 2013;16(8):1007–1021.
    1. Clarke PM, Gray AM, Briggs A, Farmer AJ, Fenn P, Stevens RJ, et al. A model to estimate the lifetime health outcomes of patients with type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68) Diabetologia. 2004;47(10):1747–1759.
    1. Hayes AJ, Leal J, Gray AM, Holman RR, Clarke PM. UKPDS outcomes model 2: a new version of a model to simulate lifetime health outcomes of patients with type 2 diabetes mellitus using data from the 30 year United Kingdom Prospective Diabetes Study: UKPDS 82. Diabetologia. 2013;56(9):1925–1933.
    1. McEwan P, Ward T, Bennett H, Bergenheim K. Validation of the UKPDS 82 risk equations within the Cardiff Diabetes Model. Cost Eff Resour Alloc. 2015;13:12.
    1. McEwan P, Peters JR, Bergenheim K, Currie CJ. Evaluation of the costs and outcomes from changes in risk factors in type 2 diabetes using the Cardiff stochastic simulation cost-utility model (DiabForecaster) Curr Med Res Opin. 2006;22(1):121–129.
    1. Canadian Agency for Drugs and Technologies in Health (CADTH). Therapeutic review of third-line drugs for type 2 diabetes—an update. 2018. . Accessed Oct 2018.
    1. Lundqvist A, Steen Carlsson K, Johansen P, Andersson E, Willis M. Validation of the IHE cohort model of type 2 diabetes and the impact of choice of macrovascular risk equations. PloS One. 2014;9(10):e110235.
    1. Novo Nordisk Canada Inc. Ozempic® approved in Canada for the treatment of adults with type 2 diabetes. 2018. . Accessed 5 Mar 2018.
    1. Canadian Agency for Drugs and Technologies in Health (CADTH). Dulaglutide. 2015. . Accessed Sept 2018.
    1. Sorli C, Harashima SI, Tsoukas GM, Unger J, Karsbøl JD, Hansen T, et al. Efficacy and safety of once-weekly semaglutide monotherapy versus placebo in patients with type 2 diabetes (SUSTAIN 1): a double-blind, randomised, placebo-controlled, parallel-group, multinational, multicentre phase 3a trial. Lancet Diabetes Endocrinol. 2017;5(4):251–260.
    1. Rodbard HW, Lingvay I, Reed J, de la Rosa R, Rose L, Sugimoto D, et al. Semaglutide added to basal insulin in type 2 diabetes (SUSTAIN 5): a randomized, controlled trial. J Clin Endocrinol Metab. 2018;103(6):2291–2301.
    1. Pratley RE, Aroda VR, Lingvay I, Ludemann J, Andreassen C, Navarria A, et al. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol. 2018;6(4):275–286.
    1. Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jodar E, Leiter LA, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834–1844.
    1. Aroda VR, Bain SC, Cariou B, Piletic M, Rose L, Axelsen M, et al. Efficacy and safety of once-weekly semaglutide versus once-daily insulin glargine as add-on to metformin (with or without sulfonylureas) in insulin-naive patients with type 2 diabetes (SUSTAIN 4): a randomised, open-label, parallel-group, multicentre, multinational, phase 3a trial. Lancet Diabetes Endocrinol. 2017;5(5):355–366.
    1. Ahrén B, Masmiquel L, Kumar H, Sargin M, Karsbol JD, Jacobsen SH, et al. Efficacy and safety of once-weekly semaglutide versus once-daily sitagliptin as an add-on to metformin, thiazolidinediones, or both, in patients with type 2 diabetes (SUSTAIN 2): a 56-week, double-blind, phase 3a, randomised trial. Lancet Diabetes Endocrinol. 2017;5(5):341–354.
    1. Ahmann AJ, Capehorn M, Charpentier G, Dotta F, Henkel E, Lingvay I, et al. Efficacy and safety of once-weekly semaglutide versus exenatide ER in subjects with type 2 diabetes (SUSTAIN 3): a 56-week, open-label, randomized clinical trial. Diabetes Care. 2018;41(2):258–266.
    1. Kiadaliri AA, Gerdtham UG, Nilsson P, Eliasson B, Gudbjornsdottir S, Carlsson KS. Towards renewed health economic simulation of type 2 diabetes: risk equations for first and second cardiovascular events from Swedish register data. PloS One. 2013;8(5):e62650.
    1. Bagust A, Hopkinson PK, Maier W, Currie CJ. An economic model of the long-term health care burden of Type II diabetes. Diabetologia. 2001;44(12):2140–2155.
    1. Brown JB, Russell A, Chan W, Pedula K, Aickin M. The global diabetes model: user friendly version 3.0. Diabetes Res Clin Pract. 2000;50(Suppl 3):S15–S46.
    1. Eastman RC, Javitt JC, Herman WH, Dasbach EJ, Zbrozek AS, Dong F, et al. Model of complications of NIDDM. I. Model construction and assumptions. Diabetes Care. 1997;20(5):725–734.
    1. Ericsson Å, Lundqvist A. Cost effectiveness of insulin degludec plus liraglutide (IDegLira) in a fixed combination for uncontrolled type 2 diabetes mellitus in Sweden. Appl Health Econ Health Policy. 2017;15(2):237–248.
    1. Ericsson Å, Glah D, Lorenzi M, Jansen JP, Fridhammar A. Cost-effectiveness of liraglutide versus lixisenatide as add-on therapies to basal insulin in type 2 diabetes. PloS One. 2018;13(2):e0191953.
    1. Steen Carlsson K, Persson U. Cost-effectiveness of add-on treatments to metformin in a Swedish setting: liraglutide vs sulphonylurea or sitagplitin. J Med Econ. 2014;17(9):658–669.
    1. Kiadaliri AA, Gerdtham UG, Eliasson B, Carlsson KS. Cost-utility analysis of glucagon-like peptide-1 agonists compared with dipeptidyl peptidase-4 inhibitors or neutral protamine Hagedorn basal insulin as add-on to metformin in type 2 diabetes in Sweden. Diabetes Ther. 2014;5(2):591–607.
    1. The Dental and Pharmaceutical Benefits Agency (TLV). Lyxumia is included in the reimbursement system with limitation (Lyxumia ingår i högkostnadsskyddet med begränsning). 2015. . Accessed Jan 2018.
    1. The Dental and Pharmaceutical Benefits Agency (TLV). Xultophy is included in the reimbursement system with limitation (Xultophy ingår i högkostnadsskyddet med begränsning). 2015. . Accessed Oct 2018.
    1. Socialstyrelsen. National guidelines for diabetes care—support for governance and management. 2015. . Accessed Oct 2018.
    1. Canadian Agency for Drugs and Technologies in Health (CADTH). Therapeutic review. New drugs for type 2 diabetes: second-line therapy—science report. 2018. . Accessed Jun 2018.
    1. Palmer AJ, Si L, Tew M, Hua X, Willis MS, Asseburg C, et al. Computer modeling of diabetes and its transparency: a report on the Eighth Mount Hood challenge. Value Health. 2018;21(6):724–731.
    1. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)—explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health. 2013;16(2):231–250.
    1. Heap G. Type 2 diabetes current treatment detailed, expanded analysis: physician insights (EU5). Decision Resources Group. 2017. . Accessed Jan 2019.
    1. Hunt B, Vega-Hernandez G, Valentine WJ, Kragh N. Evaluation of the long-term cost-effectiveness of liraglutide vs lixisenatide for treatment of type 2 diabetes mellitus in the UK setting. Diabetes Obes Metab. 2017;19(6):842–849.
    1. Mezquita-Raya P, Ramirez de Arellano A, Kragh N, Vega-Hernandez G, Pohlmann J, Valentine WJ, et al. Liraglutide versus lixisenatide: long-term cost-effectiveness of GLP-1 receptor agonist therapy for the treatment of type 2 diabetes in Spain. Diabetes Ther. 2017;8(2):401–415.
    1. Hunt B, Kragh N, McConnachie CC, Valentine WJ, Rossi MC, Montagnoli R. Long-term cost-effectiveness of two GLP-1 receptor agonists for the treatment of type 2 diabetes mellitus in the Italian setting: liraglutide versus lixisenatide. Clin Ther. 2017;39(7):1347–1359.
    1. Kahn SE, Haffner SM, Heise MA, Herman WH, Holman RR, Jones NP, et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med. 2006;355(23):2427–2443.
    1. Willis M, Neslusan C, Nilsson A, Asseburg C. Assessing the value of canagliflozin (CANA) vs. sitagliptin (SITA) as second-line therapy in the U.S.—the importance of considering evidence from the CANVAS program. Diabetes. 2018;67(Suppl 1):1272-P.
    1. National Institute for Health and Care Excellence. Multiple technology appraisal: canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes. 2016. . Accessed Oct 2018.
    1. National Institute for Health and Care Excellence. Type 2 diabetes in adults: management [NG28]. Appendix F: full health economics report. 2015. . Accessed Jan 2019.
    1. Willis M, Asseburg C, Nilsson A, Johnsson K, Kartman B. Multivariate prediction equations for HbA1c lowering, weight change, and hypoglycemic events associated with insulin rescue medication in type 2 diabetes mellitus: informing economic modeling. Value Health. 2017;20(3):357–371.
    1. Bagust A, Beale S. Modelling EuroQol health-related utility values for diabetic complications from CODE-2 data. Health Econ. 2005;14(3):217–230.
    1. Ward A, Alvarez P, Vo L, Martin S. Direct medical costs of complications of diabetes in the United States: estimates for event-year and annual state costs (USD 2012) J Med Econ. 2014;17(3):176–183.
    1. Eckert KA, Carter MJ, Lansingh VC, Wilson DA, Furtado JM, Frick KD, et al. A simple method for estimating the economic cost of productivity loss due to blindness and moderate to severe visual impairment. Ophthalmic Epidemiol. 2015;22(5):349–355.
    1. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee Diabetes Canada 2018 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2018;42:S1–S325.
    1. Willis M, Neslusan C, Johansen P, Nilsson A. The importance of considering the evolving evidence base on cardiovascular (CV) effects of antihyperglycemic agents (AHAs) on estimates of “value for money”. Presented at American Diabetes Association (ADA) 77th scientific sessions, San Diego, CA, USA, 9–13 June 2017.
    1. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577–1589.
    1. Evans M, Johansen P, Vraziv H. Incorporating cardioprotective effects of once-weekly semaglutide in estimates of health benefits for patients with type 2 diabetes. Diabetes. 2018;67(Suppl 1):1273-P.
    1. . Researching cardiovascular events with a weekly incretin in diabetes (REWIND). 2017. . Accessed July 2017.
    1. Eli Lilly. Trulicity® (dulaglutide) demonstrates superiority in reduction of cardiovascular events for broad range of people with type 2 diabetes. 2018. . Accessed Nov 2018.
    1. Basu S, Sussman JB, Berkowitz SA, Hayward RA, Yudkin JS. Development and validation of risk equations for complications of type 2 diabetes (RECODe) using individual participant data from randomised trials. Lancet Diabetes Endocrinol. 2017;5(10):788–798.
    1. Shao H, Fonseca V, Stoecker C, Liu S, Shi L. Novel risk engine for diabetes progression and mortality in USA: building, relating, assessing, and validating outcomes (BRAVO) Pharmacoeconomics. 2018;36(9):1125–1134.
    1. Viljoen A, Hoxer CS, Johansen P, Malkin S, Hunt B, Bain SC. Evaluation of the long-term cost-effectiveness of once-weekly semaglutide versus dulaglutide for the treatment of type 2 diabetes mellitus in the UK. Diabetes Obes Metab. 2019;21(3):611–621.
    1. Tikkanen C, Johansen P, Hunt B, Malkin S, Pollock R. Once-weekly semaglutide provides better health outcomes compared to dulaglutide as dual therapy in the treatment of type 2 diabetes: a cost-effectiveness analysis. Presented at the EASD 54th annual meeting, Berlin, Germany, 1–5 October 2018.
    1. Laegemiddelstyrelsen (Danish Medicines Agency). Ozempic® får generelt klausuleret tilskud. 2018. . Accessed Aug 2018.
    1. Health Service Executive Ireland. Ozempic. Health Service Executive Ireland. 2018. . Accessed Oct 2018.
    1. Bundesamt für Gesundheit BAG. BAG-Bulletin: Informationsmagazin für medizinische Fachpersonen und Medienschaffende. Bundesamt für Gesundheit BAG. 2018. . Accessed Oct 2018.
    1. Canadian Agency for Drugs and Technologies in Health (CADTH). Guidelines for the economic evaluation of health technologies: Canada. 2017. . Accessed Aug 2018.
    1. Fenwick EK, Xie J, Ratcliffe J, Pesudovs K, Finger RP, Wong TY, et al. The impact of diabetic retinopathy and diabetic macular edema on health-related quality of life in type 1 and type 2 diabetes. Investig Ophthalmol Vis Sci. 2012;53(2):677–684.
    1. Canadian Agency for Drugs and Technologies in Health (CADTH). Optimal use recommendations for second- and third-line therapy for patients with type 2 diabetes. CADTH optimal use report. Ottawa, CADTH; 2013. . Accessed June 2018.
    1. Currie CJ, McEwan P, Poole C, Valentine WJ, Palmer AJ, Lammert M, et al. Comments on: long-term clinical and cost outcomes of treatment with biphasic insulin aspart 30/70 versus insulin glargine in insulin-naive type 2 diabetes patients: cost-effectiveness analysis in the UK setting. Curr Med Res Opin. 2006;22(5):967–969.
    1. Sørensen J, Ploug U. The cost of diabetes-related complications: registry-based analysis of days absent from work. Econ Res Int. 2013;8:article ID 618039.
    1. Working Days. Working days in Canada. 2017. . Accessed Aug 2018.
    1. Johansen P, Håkan-Bloch J, Liu AD, Persson S, Toresson Grip E. Cost-effectiveness of once-weekly semaglutide 1.0 mg vs. dulaglutide 1.5 mg as add-on to metformin in the treatment of type 2 diabetes in Canada. Diabetes. 2018;67(Suppl 1):136-LB.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever