Real-world cost-effectiveness of insulin degludec in type 1 and type 2 diabetes mellitus from a Swedish 1-year and long-term perspective

Abstract

Background and aims

The ReFLeCT study demonstrated that switching to insulin degludec from other basal insulins was associated with reductions in glycated hemoglobin and hypoglycemic events in type 1 (T1D) and type 2 diabetes (T2D), and reductions in insulin doses in T1D. The aim of the present analysis was to assess the short- and long-term cost-effectiveness of switching to insulin degludec in Sweden.

Methods

Short-term outcomes were evaluated over 1 year in a Microsoft Excel model, while long-term outcomes were projected over patient lifetimes using the IQVIA CORE Diabetes Model. Cohort characteristics and treatment effects were sourced from the ReFLeCT study. Costs (in 2018 Swedish krona [SEK]) encompassed direct medical expenditure and indirect costs from loss of workplace productivity. In the long-term analyses, patients were assumed to receive insulin degludec or continue prior insulin therapy (primarily insulin glargine U100) for 5 years, before all patients intensified to once-daily degludec and mealtime aspart.

Results

Switching to insulin degludec was associated with improved quality-adjusted life expectancy of 0.04 and 0.02 quality-adjusted life years (QALYs) over 1 year, and 0.16 and 0.08 QALYs over patient lifetimes, in T1D and T2D. Combined costs in T1D and T2D were estimated to be SEK 1,249 lower and SEK 1,181 higher over the short-term, and SEK 157,258 and SEK 2,114 lower over the long-term. Benefits were due to lower insulin doses in T1D, reduced rates of hypoglycemia, and lower incidences of diabetes-related complications. Insulin degludec was associated with an incremental cost-effectiveness ratio of SEK 64,298 per QALY gained for T2D over 1 year and considered dominant for T1D and T2D in all other comparisons.

Conclusions

Insulin degludec was projected to be cost-effective or dominant versus other basal insulins for the treatment of T1D and T2D in Sweden.

Keywords:

• Cost
• cost-effectiveness
• insulin degludec
• Sweden
• type 1 diabetes
• type 2 diabetes

JEL classification codes:

• I15
• I19

Transparency

Declaration of funding

This study was supported by funding from Novo Nordisk Scandinavia AB, Malmö, Sweden. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Declaration of financial/other interests

JJ has received speaker’s and or consultant fees from Abbott, Ascensia, AstraZeneca, Boehringer Ingelheim, Eli-Lilly, Medtronic, Nordic Infucare, Novo Nordisk, and Sanofi. ÅE and ACM are employees of Novo Nordisk Scandinavia AB. BE and SS have no relevant or material financial interests that relate to the research described. JG and JDDRF are employees of Novo Nordisk A/S. BH and SJPM are employees of Ossian Health Economics and Communications, which received consulting fees from Novo Nordisk Scandinavia AB to support preparation of the analysis. MT has received speaker’s fees from AstraZeneca, Eli-Lilly, Novo Nordisk, and Sanofi. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

None reported.

Data availability statement

All data generated or analyzed during this study are included in this published article/as supplementary information files.