Cost-effectiveness of switching to insulin degludec from other basal insulins in real-world clinical practice in Italy

Abstract

Aims: The costs associated with insulin therapy and diabetes-related complications represent a significant and growing economic burden for healthcare systems. The aim of this study was to evaluate the cost-effectiveness of switching to insulin degludec (degludec) vs continuing previous basal insulin, in Italian patients with type 1 (T1D) or type 2 (T2D) diabetes, using a long-term economic model.

Materials and methods: Data were retrieved from a real-world population of patients from clinical practice in Italy. Clinical parameters included in the base-case model were change from baseline in HbA_1c, rates of hypoglycemia, and basal and bolus insulin dose, at 6 months following switch to degludec. Costs of treatments were taken from official Italian pharmaceutical list prices and costs of hypoglycemia were based on the literature. The data were used to populate a long-term (lifetime) IQVIA CORE Diabetes Model to evaluate the incremental cost-effectiveness ratio (ICER) – cost per quality-adjusted life-year (QALY). The robustness of these results was tested with extensive sensitivity analyses by varying the time horizons and abolishing each of the treatment differences and previous basal insulins.

Results: The total incremental cost for degludec vs previous basal insulin was €–6,310 and €–2,682 for patients with T1D and T2D, respectively; the switch to degludec resulted in a QALY gain of 0.781 and 0.628. The long-term ICER for degludec vs continuing the previous basal insulin regimen showed that degludec was dominant for both T1D and T2D, meaning that patient health was improved in terms of QALYs with lower healthcare costs. Sensitivity analyses showed that degludec remained dominant in most scenarios including after elimination of any benefit in non-severe hypoglycemia and insulin dose, in both T1D and T2D.

Conclusions: Under routine care, switching to degludec is dominant, compared with continuing previous basal insulin, in Italian patients with T1D or T2D.

Keywords:

• Cost-effectiveness
• insulin degludec
• Italy
• real-world evidence

JEL CLASSIFICATION CODES:

• I19
• C15

Transparency

Declaration of funding

Sponsorship for the EU-TREAT study, this study, and article processing charges were funded by Novo Nordisk A/S.

Declaration of financial/other relationships

SH was an employee of Novo Nordisk at the time of the study; JG and MLW are employees of, and own stocks/shares in, Novo Nordisk A/S. AL declares no relevant conflict of interest. The peer reviewers on this manuscript have received an honorarium from JME for their review work. In addition, a reviewer on this manuscript discloses that they have consulted for Eli Lilly and Co. The reviewers have no other relevant financial relationships or otherwise to disclose.

Acknowledgements

The authors thank Deniz Tutkunkardas, Novo Nordisk A/S, for his review of, and input to, the manuscript, and also thank Barnaby Hunt, Ossian Health Economics and Communications GmbH, for the CORE Diabetes Model simulations. Medical writing and editorial support, under the guidance of the authors, was provided by Jin Heppell and Richard McDonald, of Watermeadow Medical, an Ashfield company, part of UDG Healthcare plc, funded by Novo Nordisk.

Previous presentations

The data in this manuscript have not been previously published in this format. Some of the data in this manuscript have been presented in a poster at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 20th Annual European Congress 2017, 4–8 November 2017, Glasgow, UK (https://www.ispor.org/ScientificPresentationsDatabase/Presentation/76435?pdfid=52786).

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.