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

Figures & data

Table 1. Insulin doses and treatment effects from the ReFLeCT study applied in the cost-effectiveness analyses of insulin degludec in type 1 and type 2 diabetes in Sweden.

Parameter	Type 1 diabetes		Type 2 diabetes
	Switching to insulin degludec	Continuation of previous insulin therapy	Switching to insulin degludec	Continuation of previous insulin therapy
Daily insulin doses (IU)
Basal insulin	22.8	25.0	37.5	37.5
Bolus insulin	23.8	27.3	38.9	38.9
Physiological parameters applied in the first year of the long-term analysis
HbA1c (%)	−0.15 (0.04)	0 (0)	−0.32 (0.05)	0 (0)
HbA1c (mmol/mol)	−1.6 (0.4)	0 (0)	−3.5 (0.5)	0 (0)
Body mass index (kg/m^2)	0.28 (0.07)	0 (0)	0 (0)*	0 (0)
Hypoglycemic events applied in the short- and long-term analyses
Non-severe hypoglycemic events (per 100 patient-years)	6,530	7,896	764	1,402
Severe hypoglycemic events (per 100 patient-years)	22.7	81.0	2.00	2.00
Proportion of nocturnal non-severe hypoglycemic events	0.08	0.10	0.06	0.09
Proportion of nocturnal severe hypoglycemic events	0.00	0.00	0.00	0.00

Abbreviations. HbA1c, glycated hemoglobin; IU, international units.

Values are means (standard deviations).

*Difference reported in the ReFLeCT study did not reach statistical significance and was therefore not applied in the analysis.

Table 2. Short-term cost-effectiveness outcomes of insulin degludec versus continuation of previous insulin therapy in type 1 and type 2 diabetes in Sweden.

Health outcomes	Switching to insulin degludec	Continuation of previous insulin therapy	Difference
Type 1 diabetes
Quality-of-life (QALYs)	0.74	0.70	+0.04
Direct costs (SEK)	11,778	12,573	−795
Combined costs (SEK)	12,582	13,830	−1 249
ICER based on direct costs	Insulin degludec dominant
ICER based on combined costs	Insulin degludec dominant
Type 2 diabetes
Quality-of-life (QALYs)	0.74	0.72	+0.02
Direct costs (SEK)*	12,881	11,699	+1 181
ICER based on direct costs*	SEK 64,298 per QALY gained

Abbreviations. ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year; SEK, 2018 Swedish krona.

Values are means. Combined costs are a sum of direct and indirect costs.

*Only direct costs were accrued in the type 2 diabetes analysis, as the mean age of the population at baseline was greater than the defined retirement age.

Figure 1. Short-term mean direct costs over 1 year in the cost-effectiveness analyses of insulin degludec in type 1 and type 2 diabetes in Sweden. SEK, 2018 Swedish krona.

Table 3. Long-term cost-effectiveness outcomes of insulin degludec versus continuation of previous insulin therapy in type 1 and type 2 diabetes in Sweden.

Health outcomes	Switching to insulin degludec	Continuation of previous insulin therapy	Difference
Type 1 diabetes
Undiscounted life expectancy (years)	29.36	29.23	+0.13
Discounted life expectancy (years)	18.21	18.15	+0.06
Discounted quality-adjusted life expectancy (QALYs)	12.78	12.62	+0.16
Discounted direct costs (SEK)	658,848	666,407	−7,559
Discounted combined costs (SEK)	3,900,725	4,057,983	−157,258
ICER based on direct costs	Insulin degludec dominant
ICER based on combined costs	Insulin degludec dominant
Type 2 diabetes
Undiscounted life expectancy (years)	16.96	16.88	+0.08
Discounted life expectancy (years)	12.29	12.24	+0.05
Discounted quality-adjusted life expectancy (QALYs)	8.48	8.40	+0.08
Discounted direct costs (SEK)*	552,358	554,472	−2,114
ICER based on direct costs*	Insulin degludec dominant

Abbreviations. ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year; SEK, 2018 Swedish krona.

Values are means. Combined costs are a sum of direct and indirect costs.

*Only direct costs were accrued in the type 2 diabetes analysis, as the mean age of the population at baseline was greater than the defined retirement age.

Figure 2. Long-term mean direct costs over patient lifetimes in the cost-effectiveness analyses of insulin degludec in type 1 and type 2 diabetes in Sweden. SEK, 2018 Swedish krona.

Table 4. Sensitivity analysis results of insulin degludec versus continuation of previous insulin therapy in type 1 and type 2 diabetes in Sweden.

Analysis	Type 1 diabetes			Type 2 diabetes
	Δ discounted QALE (QALYs)	Δ discounted combined costs (SEK)	ICER (SEK per QALY gained)	Δ discounted QALE (QALYs)	Δ discounted combined costs (SEK)	ICER (SEK per QALY gained)
Short-term analysis
Base case	+0.04	−1,249	Degludec dominant	+0.02	+1 181	64,298
Biosimilar insulin glargine (Abasaglar) cost applied for insulin  glargine U100 in continuation of previous insulin therapy arm	+0.04	−982	Degludec dominant	+0.02	+1 562	85,035
People in the T2D cohort assumed to accrue indirect costs	―	―	―	+0.02	+560	30,500
Long-term analysis
Base case	+0.16	−157,258	Degludec dominant	+0.08	−2,114	Degludec dominant
1-year time horizon	+0.03	−39,379	Degludec dominant	+0.01	+1,095	156,379
10-year time horizon	+0.11	−149,273	Degludec dominant	+0.05	+1,249	24,890
20-year time horizon	+0.12	−154,838	Degludec dominant	+0.08	−2,757	Degludec dominant
0% discount rates	+0.23	−177,901	Degludec dominant	+0.11	−3,226	Degludec dominant
5% discount rates	+0.13	−145,558	Degludec dominant	+0.07	−1,482	Degludec dominant
HbA1c difference only	+0.04	−5,998	Degludec dominant	+0.05	−337	Degludec dominant
Hypoglycemia rate difference only	+0.09	−137,785	Degludec dominant	+0.03	+5 447	173,467
BMI difference only	+0.00	+4,040	Degludec equally effective and more costly	Difference not statistically significant
Biosimilar insulin glargine (Abasaglar) cost applied for  insulin glargine U100 in continuation of previous insulin therapy arm	+0.16	−156,107	Degludec dominant	+0.08	−574	Degludec dominant
Dose difference abolished	+0.16	−154,622	Degludec dominant	Difference not statistically significant
Biosimilar insulin glargine (Abasaglar) cost applied for insulin glargine U100  in continuation of previous insulin therapy arm and dose difference abolished	+0.16	−153,471	Degludec dominant	Difference not statistically significant

Abbreviations. BMI, body mass index; HbA1c, glycated hemoglobin; ICER, incremental cost-effectiveness ratio; QALE, quality-adjusted life expectancy; QALY, quality-adjusted life year; SEK, 2018 Swedish krona.

Combined costs are a sum of direct and indirect costs.

Data availability statement

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