Cost-effectiveness of switching to insulin degludec from other basal insulins: evidence from Swedish real-world data

Abstract

Objectives: Health economic analysis from a healthcare and societal point of view was conducted to assess the cost-effectiveness of insulin degludec (IDeg) after switching from other basal insulins in people with type 1 diabetes.

Material and methods: This was a prospective, open-label, single arm, observational follow-up from August 2013 to October 2015 of 476 consecutive patients at Danderyd Hospital (Stockholm, Sweden) who switched to IDeg from other basal insulins (99% basal insulin analogs). The IMS CORE Diabetes Model (CDM) was used to predict the cost-effectiveness of life-long treatment with IDeg vs. other basal insulins, based on a Swedish setting.

Results: Mean (SD) duration of follow-up was 21.7 (6.0) weeks. Mean HbA_1c decreased by 2.7 mmol/mol, mean basal insulin dose decreased by 13.1% (p < .0001), and mean bolus insulin dose decreased by 7.5% (p < .0001) after switching. Frequencies of non-severe daytime hypoglycemia and non-severe nocturnal hypoglycemia decreased by 12% (p = .0127) and 53% (p < .0001) respectively and severe hypoglycemia was reduced by 62% (p = .0225). The CDM predicted a gain in life expectancy of 0.33 years, a discounted gain in quality-adjusted life-years (QALYs) of 0.54, and lower estimated direct lifetime healthcare costs of SEK 22,757 for patients switching to IDeg. The incremental cost-effectiveness ratio (ICER) showed IDeg as dominant (i.e. higher effectiveness with a lower cost). Sensitivity analyses confirmed the results.

Conclusion: Based on this prospective, real-world, follow-up and using the CDM, it was estimated that switching to IDeg from other basal insulins translated into QALY gains including improved life expectancy and health-related quality of life, as well as dominant ICER, meaning cost-savings for the healthcare system. However, the study is limited by its observational design. Extrapolation into the future is only estimated since the actual treatment effect cannot be projected with certainty.

Keywords:

• Basal insulin analogs
• cost-effectiveness
• health economics
• hypoglycemia
• insulin degludec
• Type 1 diabetes

Transparency

This study was funded by Novo Nordisk.

Author contributions: L.L-H., J.G., Å.E., and S.E.-Z. all contributed to the design and writing of the manuscript, interpretation of the data, reviewed drafts, approve the submission, and agree to be accountable for all aspects of the work. Individual authors also contributed as follows. L.L.-H. collected the data with the help from all members of the diabetes team at Danderyd hospital. J.G. conducted the health economic analysis. Å.E. was involved in conception and design of the analysis and assisted with input of the cost data for the model.

Declaration of financial/other relationships

L.L.-H. has disclosed that she has served on advisory boards and consulted for Novo Nordisk, received research support from Sanofi and has also received honoraria for giving lectures for Novo Nordisk, Sanofi, Lilly, Abbott, Bayer, Boehringer-Ingelheim and Amgen. J.G., Å.E., and S.E.-Z. have disclosed that they are employees of Novo Nordisk and also hold stock in Novo Nordisk.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Medical writing and submission support were provided by Gary Patronek and Gabrielle Parker of Watermeadow Medical, an Ashfield company, part of UDG Healthcare plc, funded by Novo Nordisk. We thank Christian Klyver Tikkanen and Michiel CE Van Leuven (Novo Nordisk) for their review and input to the manuscript.