Long-term Cost-effectiveness of Insulin Degludec Versus Insulin Glargine U100 in the UK: Evidence from the Basal-bolus Subgroup of the DEVOTE Trial (DEVOTE 16).

Abstract

OBJECTIVES:

To evaluate the cost-effectiveness of insulin degludec (degludec) versus insulin glargine 100 units/mL (glargine U100) in basal-bolus regimens for patients with type 2 diabetes (T2D) at high cardiovascular (CV) risk based on the DEVOTE CV outcomes trial.

METHODS:

A microsimulation model, informed by clinical outcomes from the subgroup of patients using basal-bolus insulin therapy in DEVOTE (NCT01959529) and by the UKPDS Outcomes Model 2 risk equations, was used to model direct costs (2018 GBP) and effectiveness outcomes [quality-adjusted life years (QALYs)] with degludec versus glargine U100 over a 40-year time horizon. The model captured the development of eight diabetes-related complications, death, severe hypoglycemia and insulin dosing. This analysis was conducted from the perspective of National Health Service (NHS) England.

RESULTS:

Treatment with degludec versus glargine U100 in basal-bolus regimens was associated with improved clinical outcomes at a higher cost per patient [incremental cost effectiveness ratio (ICER): £14,956 GBP/QALY]. Degludec remained cost effective versus glargine U100 in all exploratory sensitivity analyses, with ICERs below the widely accepted willingness-to-pay threshold, although the result was most sensitive to assumptions regarding the persistence of treatment effects.

CONCLUSIONS:

Our long-term modeling analysis suggested that degludec was cost effective (from the perspective of NHS England) versus glargine U100 in basal-bolus regimens for patients with T2D at high CV risk. Our findings raise important questions regarding how to model the health economics of diabetes therapies.

• Authors: Richard F Pollock, William J Valentine, Steven P Marso, Andreas Andersen, Jens Gundgaard, Nino Hallén, Deniz Tutkunkardas, Elizabeth A Magnuson, John B Buse, DEVOTE study group
• Journal: Applied health economics and health policy (Appl Health Econ Health Policy) Vol. 17 Issue 5 Pg. 615-627 (10 2019) ISSN: 1179-1896 [Electronic] New Zealand
• PMID: 31264138 (Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Hypoglycemic Agents
• Insulin, Long-Acting
• Insulin Glargine
• insulin degludec

Topics

• Aged
• Cost-Benefit Analysis
• Diabetes Mellitus, Type 2 (drug therapy, economics)
• Double-Blind Method
• Female
• Humans
• Hypoglycemic Agents (economics)
• Insulin Glargine (economics)
• Insulin, Long-Acting (economics)
• Male
• Middle Aged
• Monte Carlo Method
• Quality-Adjusted Life Years
• State Medicine (economics)
• United Kingdom