The cost-effectiveness of dulaglutide versus insulin glargine for the treatment of type 2 diabetes mellitus in Japan

<p><b>Aims:</b> Dulaglutide is a new once weekly glucagon-like peptide-1 (GLP-1) receptor agonist administered via a disposable auto-injection pen for the management of type 2 diabetes mellitus (T2DM). The objective of this study was to estimate the cost-effectiveness of dulaglutide vs insulin glargine for the management of T2DM from a Japanese healthcare perspective, in accordance with recently approved Japanese Cost-Effectiveness Guidelines.</p> <p><b>Methods:</b> The IQVIA CORE Diabetes Model (version 9) was used to estimate the long-term costs and effects of treatment with dulaglutide and insulin glargine. Direct comparative data from the Araki 2015 trial (NCT01584232) was used to inform the analysis. Costs associated with treatment and complications were derived from Japanese sources wherever possible and inflated to 2015 Japanese Yen (JPY). Utilities were based upon a European systematic review of diabetes utilities and adjusted for use in a Japanese population. One-way and probabilistic sensitivity analyses (OWSA and PSA) were conducted on all inputs and key modeling assumptions.</p> <p><b>Results:</b> Dulaglutide 0.75 mg was associated with higher quality-adjusted life years (QALYs), life years (LYs), and total costs, compared to insulin glargine, resulting in an incremental cost-effectiveness ratio (ICER) of 416,280 JPY/QALY gained. Treatment with dulaglutide increased the time alive and free from diabetes-related complications by 4 months. OWSA and PSA indicated that results were robust to plausible variations in input parameters and modeling assumptions.</p> <p><b>Limitations:</b> Key limitations of this study are similar to other cost-utility analyses of diabetes, including the extrapolation of short-term clinical trial data into lifelong durations. In addition, due to the lack of robust published Japanese data, some values were derived from non-Japanese sources.</p> <p><b>Conclusions:</b> This analysis suggests that dulaglutide 0.75 mg may be a cost-effective treatment alternative to insulin glargine for patients with T2DM in Japan.</p

Benchmarking the Cost per Person of Mass Treatment for Selected Neglected Tropical Diseases: An Approach Based on Literature Review and Meta-regression with Web-Based Software Application

<div><p>Background</p><p>Advocacy around mass treatment for the elimination of selected Neglected Tropical Diseases (NTDs) has typically put the cost per person treated at less than US$0.50. Whilst useful for advocacy, the focus on a single number misrepresents the complexity of delivering “free” donated medicines to about a billion people across the world. We perform a literature review and meta-regression of the cost per person per round of mass treatment against NTDs. We develop a web-based software application (<a href="https://healthy.shinyapps.io/benchmark/" target="_blank">https://healthy.shinyapps.io/benchmark/</a>) to calculate setting-specific unit costs against which programme budgets and expenditures or results-based pay-outs can be benchmarked.</p><p>Methods</p><p>We reviewed costing studies of mass treatment for the control, elimination or eradication of lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, onchocerciasis, trachoma and yaws. These are the main 6 NTDs for which mass treatment is recommended. We extracted financial and economic unit costs, adjusted to a standard definition and base year. We regressed unit costs on the number of people treated and other explanatory variables. Regression results were used to “predict” country-specific unit cost benchmarks.</p><p>Results</p><p>We reviewed 56 costing studies and included in the meta-regression 34 studies from 23 countries and 91 sites. Unit costs were found to be very sensitive to economies of scale, and the decision of whether or not to use local volunteers. Financial unit costs are expected to be less than 2015 US$ 0.50 in most countries for programmes that treat 100 thousand people or more. However, for smaller programmes, including those in the “last mile”, or those that cannot rely on local volunteers, both economic and financial unit costs are expected to be higher.</p><p>Discussion</p><p>The available evidence confirms that mass treatment offers a low cost public health intervention on the path towards universal health coverage. However, more costing studies focussed on elimination are needed. Unit cost benchmarks can help in monitoring value for money in programme plans, budgets and accounts, or in setting a reasonable pay-out for results-based financing mechanisms.</p></div

Results from meta-regression of (log) unit costs in 2015 US$

<p>Results from meta-regression of (log) unit costs in 2015 US$</p

Summary statistics for 34 studies of 23 countries and 91 sites over 19 years

<p>Summary statistics for 34 studies of 23 countries and 91 sites over 19 years</p

Economic unit costs (excluding volunteer time) and population treated, by study (across years, sites and comparators).

<p>Dots represent individual study results, and lines represent the least squares line of best fit for studies with more than two results. The horizontal line at US$ 0.50 marks the oft-cited unit cost typically used in advocacy.</p

Availability of costing studies among low- and middle-income countries, by disease.

<p>Most recent year refers to the most recent year of study, not the most recent year of publication.</p

Financial unit cost benchmarks in low- and middle-income countries at different scales of implementation, using volunteers but excluding the (economic) cost of volunteer time.

<p>The legend excludes Vanuatu. See <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005037#pntd.0005037.s006" target="_blank">S5 Table</a> in the Supplemental Information for results for Vanuatu.</p

Financial unit cost and population treated, by study (across years, sites and comparators).

<p>Dots represent individual study results, and lines represent the least squares line of best fit for studies with more than two results. The horizontal line at US$ 0.50 marks the oft-cited unit cost typically used in advocacy.</p

Classification of financial and economic unit costs (excluding medicines¹)

<p>Classification of financial and economic unit costs (excluding medicines<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005037#t001fn001" target="_blank">¹</a>)</p