Insulin degludec versus insulin glargine U100 for patients with type 1 or type 2 diabetes in the US: a budget impact analysis with rebate tables

Abstract

Background and aims: Drug rebates are almost universally negotiated privately between the manufacturer and the payer in the US. The aim of the present study was to illustrate the use of a “rebate table” to improve the transparency and utility of published budget impact analyses in the US by modeling ranges of hypothetical rebates for two comparators. Worked examples were conducted to illustrate the budgetary implications of using insulin degludec (IDeg) relative to insulin glargine (IGlar) U100 in patients with type 1 or 2 diabetes.

Methods: A short-term (1-year) budget impact model was developed to evaluate the costs of switching to IDeg from IGlar in patients with type 1 or 2 diabetes on basal-bolus and basal-only insulin, respectively. The analysis used insulin dose and hypoglycemia data from recent randomized trials, data on the prevalence of diabetes, and estimates of the proportion of patients using each insulin regimen. The model was configured to run multiple rebate scenarios to generate a rebate table in a hypothetical 1 million member commercial plan.

Results: Relative to IGlar, IDeg resulted in reductions in non-severe and severe hypoglycemia incidence and costs both in patients with type 1 and patients with type 2 diabetes. Insulin acquisition costs were higher, and respective rebates of 7.3% and 10.6% were required for IDeg to break-even with IGlar at the full list price. Incremental per member per month IDeg costs without a rebate were USD 0.04 in type 1 diabetes and USD 0.80 in type 2 diabetes.

Conclusions: Using IDeg instead of IGlar at list price could result in a modest increase in costs when considering insulin and hypoglycemia costs alone, but modest incremental rebates with IDeg would result in cost neutrality relative to IGlar. In addition, IDeg would result in reduced incidence of severe and non-severe hypoglycemia.

Keywords:

• Costs and cost analysis
• insulin
• long-acting
• diabetes mellitus, type 1
• diabetes mellitus, type 2
• United States

Transparency

Declaration of funding

This study was supported by funding from Novo Nordisk Inc.

Declaration of financial/other relationships

WSL has served on speaker and advisory panels for Novo Nordisk A/S and Insulet Corp and as an author for Novo Nordisk A/S; she has received research funding from Novo Nordisk A/S, Insulet Corp, and Eli Lilly and Company. JW is a full-time employee of Novo Nordisk, Inc. JG is a full-time employee of Nov Nordisk A/S, which manufactures and holds the marketing authorization for insulin degludec and other anti-diabetic agents. RFP is a full-time employee of Ossian Health Economics and Communications GmbH, which received consultancy fees from Novo Nordisk, Inc. to conduct the analysis and prepare the manuscript. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.