Value For Money In The Treatment Of Patients With Type 2 Diabetes Mellitus: Assessing The Long-Term Cost-Effectiveness Of IDegLira Versus iGlarLixi In Italy

Abstract

Objective

Italian treatment guidelines for type 2 diabetes mellitus (T2DM) target good glycemic control but acknowledge the associated risk of hypoglycemia. Unlike traditional antidiabetic therapies, modern treatment options such as fixed-ratio combinations of basal insulin and glucagon-like peptide 1 receptor agonists are associated with improved glycemic control, reduced body weight and low risk of hypoglycemia. The cost-effectiveness of the fixed-ratio combinations of basal insulin and glucagon-like peptide 1 receptor agonists IDegLira and iGlarLixi was assessed for Italy in patients with T2DM uncontrolled on basal insulin, to evaluate how short-term clinical benefits translate into long-term health economic outcomes.

Methods

The IQVIA CORE Diabetes Model was used to project clinical and economic outcomes over patient lifetimes. Treatment effects were sourced from an indirect treatment comparison. The analysis captured direct medical costs (expressed in 2017 Euros) from the perspective of the Italian National Health Service (NHS) and patient-related quality of life. Sensitivity analyses were performed.

Results

IDegLira was associated with gains of 0.09 life years and 0.13 quality-adjusted life years (QALYs) relative to iGlarLixi, due to a lower cumulative incidence and delayed onset of diabetes-related complications. IDegLira was associated with an incremental cost of EUR 930 over patient lifetimes, leading to an incremental cost-effectiveness ratio of EUR 7,386 per QALY gained.

Conclusion

Over the lifetime of patients with T2DM uncontrolled on basal insulin, IDegLira was associated with improved clinical outcomes at higher costs relative to iGlarLixi. At a willingness-to-pay threshold of EUR 30,000 per QALY gained, IDegLira was considered to be cost-effective versus iGlarLixi from the perspective of the Italian NHS.

Keywords:

• cost-effectiveness
• fixed-ratio combination
• IDegLira
• iGlarLixi
• Italy
• type 2 diabetes

Acknowledgments

The authors thank Monika Russel-Szymczyk for her review of and feedback on earlier versions of this manuscript.

Ethics Approval

This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.

Data Statement

Data reported in this manuscript are available from the corresponding author on reasonable request.

Author Contributions

All authors contributed to study conception and design, data acquisition, analysis and interpretation. All authors contributed to drafting and/or revising the article for intellectual content. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

Funding

The present study and preparation of the manuscript were supported by funds from Novo Nordisk, Søborg, Denmark, which also covered fees related to publication. The sponsor was involved in developing the study design and collecting input data but had no role in the analysis and interpretation of data or the writing of the manuscript. The decision to submit the manuscript for publication rested solely with the authors.

Disclosure

Marie Markert: Employee of Novo Nordisk and reports personal fees from Novo Nordisk A/S, outside the submitted work. Giusi Lastoria: Employee of Novo Nordisk. Roberta Montagnoli: Employee of Novo Nordisk. Witesh Parekh: Employee of Novo Nordisk. Johannes Pöhlmann: Employee of Ossian Health Economics and Communications, which received consulting fees from Novo Nordisk for the conduct of the study and preparation of the manuscript. Barnaby Hunt: Employee of Ossian Health Economics and Communications, which received consulting fees from Novo Nordisk for the conduct of the study and preparation of the manuscript. The authors report no other conflicts of interest in this work.