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

Abstract

Aims: 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.

Methods: 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.

Results: 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.

Limitations: 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.

Conclusions: This analysis suggests that dulaglutide 0.75 mg may be a cost-effective treatment alternative to insulin glargine for patients with T2DM in Japan.

Keywords:

• Type 2 diabetes
• cost-effectiveness
• Japan
• dulaglutide
• insulin glargine

Transparency

Declaration of funding

This paper was funded by Eli Lilly and Company.

Declaration of financial/other relationships

HI has received lecture fees from AstraZeneca K.K., Daiichi Sankyo Co. Ltd, Eli Lilly Japan K.K., Mitsubishi Tanabe Pharma Co., MSD K.K., Nippon Boehringer Ingelheim Co. Ltd, Novartis Pharma K.K., Novo Nordisk Pharma Ltd, Ono Pharmaceutical Co. Ltd, Sanofi K.K., Sumitomo Dainippon Pharma Co. Ltd, Takeda Pharmaceutical Co. Ltd, and grant/research support from Astellas Pharma Inc., AstraZeneca K.K., Daiichi Sankyo Co. Ltd., Eli Lilly Japan K.K., Kyowa Hakko Kirin Co. Ltd, Mitsubishi Tanabe Pharma Co., MSD K.K., Novo Nordisk Pharma Ltd, Ono Pharmaceutical Co. Ltd, Shionogi & Co. Ltd, Takeda Pharmaceutical Co. Ltd, and Taisho Toyama Pharmaceutical Co. Ltd. MMW and LTJ are full-time employees of IQVIA, London, UK. AS is a full-time employee of Eli Lilly and Company. SS is a full-time employee of Eli Lilly Japan. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentations

The data was published in the form of an abstract and a podium presentation at the 2016 Annual Meeting of the Japan Diabetes Society, Kyoto, Japan, on May 21, 2016.

Acknowledgments

The authors wish to acknowledge the reviewers and the editor for their detailed and helpful comments, which have contributed to the strength of this research.