Evaluation of the cost and medical resource use outcomes associated with nasal glucagon versus injectable glucagon for treatment of severe hypoglycemia in people with diabetes in Canada: a modeling analysis

Abstract

Objectives

Treatments for severe hypoglycemia aim to restore blood glucose through successful administration of rescue therapy, and choosing the most effective and cost-effective option will improve outcomes for patients and may reduce costs for healthcare payers. The present analysis aimed to compare costs and use of medical services with nasal glucagon and injectable glucagon in people with type 1 and 2 diabetes in Canada when used to treat severe hypoglycemic events when impaired consciousness precludes treatment with oral carbohydrates using an economic model, based on differences in the frequency of successful administration of the two interventions.

Methods

A decision tree model was prepared in Microsoft Excel to project outcomes with nasal glucagon and injectable glucagon. The model structure reflected real-world decision-making and treatment outcomes, based on Canada-specific sources. The model captured the use of glucagon, emergency medical services (EMS), emergency room, inpatient stay, and follow-up care. Costs were accounted for in 2019 Canadian dollars (CAD).

Results

Nasal glucagon was associated with reduced use of all medical services compared with injectable glucagon. EMS call outs were projected to be reduced by 45%, emergency room treatments by 52%, and inpatient stays by 13%. Use of nasal glucagon was associated with reduced direct, indirect, and combined costs of CAD 1,249, CAD 460, and CAD 1,709 per severe hypoglycemic event, respectively, due to avoided EMS call outs and hospital costs, resulting from a higher proportion of successful administrations.

Conclusions

When a patient with type 1 or type 2 diabetes is being treated for a severe hypoglycemic event when impaired consciousness precludes treatment with oral carbohydrate, use of nasal glucagon was projected to be dominant versus injectable glucagon in Canada reducing costs and use of medical services.

Keywords:

• Diabetes mellitus
• glucagon
• hypoglycemia
• Canada
• costs

JEL CLASSIFICATION CODES:

• I10
• I1
• I
• I19

Transparency

Declaration of funding

The study was funded by Eli Lilly and Company.

Declaration of financial/other relationships

JFY has received consulting fees for participation in advisory boards and giving lectures from Eli Lilly and Company Limited and Novo Nordisk Canada Inc. BO is an employee of Eli Lilly and Company Limited. BM is an employee of Eli Lilly and Company. DM is an employee of Eli Lilly Canada Inc. BH and WV are employees of Ossian Health Economics and Communications. Ossian received consulting fees from Eli Lilly and Company Limited to support the preparation of the analysis. GS was an employee of Eli Lilly Canada Inc. when the study was conducted. MJ was an employee of Eli Lilly Canada Inc. when the study was conducted. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors designed the study. Data from previously published studies were identified by GS. The analysis was performed by BH. All authors interpreted the results. The manuscript was drafted by BH and revised critically for important intellectual content by all other authors. All authors have approved the final version of the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgements

No assistance in the preparation of this article is to be declared.