Cost-effectiveness of switching to insulin degludec from other basal insulins: evidence from Swedish real-world data

<p><b>Objectives:</b> Health economic analysis from a healthcare and societal point of view was conducted to assess the cost-effectiveness of insulin degludec (IDeg) after switching from other basal insulins in people with type 1 diabetes.</p> <p><b>Material and methods:</b> This was a prospective, open-label, single arm, observational follow-up from August 2013 to October 2015 of 476 consecutive patients at Danderyd Hospital (Stockholm, Sweden) who switched to IDeg from other basal insulins (99% basal insulin analogs). The IMS CORE Diabetes Model (CDM) was used to predict the cost-effectiveness of life-long treatment with IDeg vs. other basal insulins, based on a Swedish setting.</p> <p><b>Results:</b> Mean (SD) duration of follow-up was 21.7 (6.0) weeks. Mean HbA_1c decreased by 2.7 mmol/mol, mean basal insulin dose decreased by 13.1% (<i>p</i> < .0001), and mean bolus insulin dose decreased by 7.5% (<i>p</i> < .0001) after switching. Frequencies of non-severe daytime hypoglycemia and non-severe nocturnal hypoglycemia decreased by 12% (<i>p</i> = .0127) and 53% (<i>p</i> < .0001) respectively and severe hypoglycemia was reduced by 62% (<i>p</i> = .0225). The CDM predicted a gain in life expectancy of 0.33 years, a discounted gain in quality-adjusted life-years (QALYs) of 0.54, and lower estimated direct lifetime healthcare costs of SEK 22,757 for patients switching to IDeg. The incremental cost-effectiveness ratio (ICER) showed IDeg as dominant (i.e. higher effectiveness with a lower cost). Sensitivity analyses confirmed the results.</p> <p><b>Conclusion:</b> Based on this prospective, real-world, follow-up and using the CDM, it was estimated that switching to IDeg from other basal insulins translated into QALY gains including improved life expectancy and health-related quality of life, as well as dominant ICER, meaning cost-savings for the healthcare system. However, the study is limited by its observational design. Extrapolation into the future is only estimated since the actual treatment effect cannot be projected with certainty.</p

Sensitivity analyses for liraglutide 1.8 mg compared with lixisenatide 20 μg (each added to basal insulin).

<p>Sensitivity analyses for liraglutide 1.8 mg compared with lixisenatide 20 μg (each added to basal insulin).</p

Base-case analysis of liraglutide 1.8 mg compared with lixisenatide 20 μg (each added to insulin glargine).

<p>Base-case analysis of liraglutide 1.8 mg compared with lixisenatide 20 μg (each added to insulin glargine).</p

Cost-effectiveness of liraglutide versus lixisenatide as add-on therapies to basal insulin in type 2 diabetes

<div><p>Background</p><p>We assessed the cost-effectiveness of the glucagon-like peptide 1 receptor agonists liraglutide 1.8 mg and lixisenatide 20 μg (both added to basal insulin) in patients with type 2 diabetes (T2D) in Sweden.</p><p>Methods</p><p>The Swedish Institute for Health Economics cohort model for T2D was used to compare liraglutide and lixisenatide (both added to basal insulin), with a societal perspective and with comparative treatment effects derived by indirect treatment comparison (ITC). Drug prices were 2016 values, and all other costs 2015 values. The cost-effectiveness of IDegLira (fixed-ratio combination of insulin degludec and liraglutide) versus lixisenatide plus basal insulin was also assessed, under different sets of assumptions.</p><p>Results</p><p>From the ITC, decreases in HbA1c were –1.32% and –0.43% with liraglutide and lixisenatide, respectively; decreases in BMI were –1.29 and –0.65 kg/m², respectively. An estimated 2348 cases of retinopathy, 265 of neuropathy and 991 of nephropathy would be avoided with liraglutide compared with lixisenatide in a cohort of 10,000 patients aged over 40 years. In the base-case analysis, total direct costs were higher with liraglutide than lixisenatide, but costs associated with complications were lower. The cost/quality-adjusted life-year (QALY) for liraglutide added to basal insulin was SEK30,802. Base-case findings were robust in sensitivity analyses, except when glycated haemoglobin (HbA1c) differences for liraglutide added to basal insulin were abolished, suggesting these benefits were driving the cost/QALY. With liraglutide 1.2 mg instead of liraglutide 1.8 mg (adjusted for efficacy and cost), liraglutide added to basal insulin was dominant over lixisenatide 20μg.IDegLira was dominant versus lixisenatide plus basal insulin when a defined daily dose was used in the model.</p><p>Conclusions</p><p>The costs/QALY for liraglutide, 1.8 or 1.2 mg, added to basal insulin, and for IDegLira (all compared with lixisenatide 20 μg added to basal insulin) were below the threshold considered low by Swedish authorities. In some scenarios, liraglutide and IDegLira were cost-saving.</p></div

Number of complications avoided in a cohort of 10,000 patients over 40 years.

<p>Number of complications avoided in a cohort of 10,000 patients over 40 years.</p

Baseline values derived from the LIRA-ADD2BASAL and DUAL II* studies [30, 44].

<p>Baseline values derived from the LIRA-ADD2BASAL and DUAL II* studies [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0191953#pone.0191953.ref030" target="_blank">30</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0191953#pone.0191953.ref044" target="_blank">44</a>].</p

Cost-effectiveness of liraglutide versus lixisenatide as add-on therapies to basal insulin in type 2 diabetes - Fig 1

<p>a) Cost-effectiveness plane and b) cost-effectiveness acceptability curve for liraglutide 1.8 mg versus lixisenatide (each added to basal insulin). Probabilistic sensitivity analysis conducted with 1000 simulations. Base-case with 3% discount rate. QALY, quality-adjusted life-year; SEK, Swedish kronor.</p

Cost/QALY for additional scenarios evaluating the cost-effectiveness of IDegLira compared with lixisenatide 20 μg added to basal insulin.

<p>Cost/QALY for additional scenarios evaluating the cost-effectiveness of IDegLira compared with lixisenatide 20 μg added to basal insulin.</p

Achieving Good Glycemic Control Early After Onset of Diabetes: A Cost-Effectiveness Analysis in Patients with Type 1 Diabetes in Sweden

<p><b>Article full text</b></p> <p><br></p> <p>The full text of this article can be found <a href="https://link.springer.com/article/10.1007/s13300-017-0344-6"><b>here</b>.</a></p> <p><br></p> <p><b>Provide enhanced content for this article</b></p> <p><br></p> <p>If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <a href="http://www.medengine.com/Redeem/”mailto:[email protected]”"><b>[email protected]</b></a>.</p> <p> </p> <p>The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.</p> <p><br></p> <p>Other enhanced features include, but are not limited to:</p> <p><br></p> <p>• Slide decks</p> <p>• Videos and animations</p> <p>• Audio abstracts</p> <p>• Audio slides</p> <p> </p> <p> </p> <p> </p> <p> </p

Additional file 1: Table S1 and Figures S1-S8. of Estimating the impact of changes in HbA1c, body weight and insulin injection regimen on health related quality-of-life: a time trade off study

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