A short-term cost-utility analysis of insulin degludec versus insulin glargine U100 in patients with type 1 or type 2 diabetes in Denmark

Figures & data

Figure 1. Model schematic.

Table 1. Health-related quality-of-life disutilities associated with severe hypoglycemia in the base case analysis and with non-severe hypoglycemia in sensitivity analysis.

Hypoglycemia severity and type	Mean disutility per event (SE)
Non-severe daytime (type 1)	0.0040 (0.0003)
Non-severe nocturnal (type 1)	0.0080 (0.0004)
Severe (type 1)	0.0470 (0.0021)
Non-severe daytime (type 2)	0.0050 (0.0003)
Non-severe nocturnal (type 2)	0.0070 (0.0004)
Severe (type 2)	0.0600 (0.0021)

SE, standard error.

Table 2. Rates of hypoglycemia in the base case analysis. Base rates were from a Danish study of self-reported hypoglycemia, while rate ratios were derived from a meta-analysis of randomized trials in the BEGIN trial program.

Events per 100 patient years	Non-severedaytime	Non-severenocturnal	Severe
Type 1 diabetes
Glargine base rate	7,657.0	2,203.8	61.72
Degludec rate ratio (SE)	1.0 (0.071)	0.83 (0.096)	1.0 (0.258)
Degludec rate	7,657.0	1,829.1	61.72
Type 2 diabetes basal-only
Glargine base rate	1,700.4	640.6	5.8
Degludec rate ratio (SE)	1.0 (0.093)	0.64 (0.152)	0.14 (0.819)
Degludec rate	1,700.4	410.0	0.8
Type 2 diabetes basal-bolus
Glargine base rate	2,941.6	906.4	11.9
Degludec rate ratio (SE)	0.83 (0.095)	0.75 (0.137)	1.0 (0.329)
Degludec rate	2,441.6	679.8	11.9

SE, standard error.

Table 3. Unit costs for healthcare resource use for patients required medical assistance for severe hypoglycemia (27.8% of patients).

Treatment/service	Cost (DKK)	Reference
Pre-hospitalization (63.5%)	4,166.05	• Cost of an ambulance (2002 cost of DKK 2,740, inflated based on CPI)^19^,^20.• 50% of fee of an emergency care visit (DAGS BG50A charge 2015), based on 50% of patients receiving treatment at the scene in a study investigating treatment by a Mobile Emergency Care Unit^21^,^24.
Hospital admission (3.2%)	12,341.41	• Lyngsie 2016. Average cost per admission of EUR 1,658 with a length of stay of 2.6 days (95% CI =2.4–2.8)^23.
HCP treatment (6.3%)	1,385.00	• DAGS SP12D charge 2015^21.
HCP follow-up (28.6%)	26.76	• Assumed conservatively to be the cost of a telephone call to a HCP^24.

CI, confidence interval; CPI, consumer price index; HCP, healthcare professional.

Table 4. Base insulin dosing and dose ratios in the reference case analysis.

	Basal insulin	Bolus insulin
Type 1 diabetes
Base dose (SE), IUs	33.10 (1.11)	35.00 (1.68)
Dose ratio (SE)	0.87 (0.02)	0.88 (0.03)
Dose in degludec arm, IUs	28.80	30.80
Type 2 diabetes basal-only
Base dose (SE), IUs	51.70 (1.35)	–
Dose ratio (SE)	0.90 (0.03)	–
Dose in degludec arm, IUs	46.53	–
Type 2 diabetes basal-bolus
Base dose (SE), IUs	66.60 (2.68)	72.70 (3.97)
Dose ratio (SE)	1.08 (0.03)	NS
Dose in degludec arm, IUs	71.93	72.70

IUs, international units; NS, not significant; SE, standard error.

Table 5. Unit costs used in the analysis.

Cost item	Price (DKK)	Cost basis
Insulin degludec	524.64	Tresiba U100 FlexTouch, 1500 IUs
Insulin glargine	424.08	Lantus Solo Star/Optiset, 1500 IUs
Biosimilar insulin glargine (sensitivity analysis)	370.28	Abasaglar KwikPen, 1500 IUs
Bolus insulin	382.60	NovoRapid FlexPen, 1500 IUs
Needle (bolus and basal injection)	1.78	PenFine needle (0.33 × 10 mm)
Self-monitoring of blood glucose test strip	7.39	Profiline Teststrimler, 50 pack
Self-monitoring of blood glucose lancet	0.70	Pura My Life, 200 pack

Price of insulins taken from www.medicinpriser.dk (June 20, 2016 to July 3, 2016), while cost of needles/SMBG tests are from Nomeco; http://service.nomeco.dk/webdoc/mrkkat.pdf (May 3, 2016).

Table 6. Base case cost-effectiveness outcomes in type 1 and 2 diabetes with basal-bolus insulin, and type 2 diabetes with a basal-only regimen.

	Costs (DKK)			Quality-adjusted life expectancy (QALYs)			ICER (DKK per QALY)
	Insulin glargine	Insulin degludec	Incremental	Insulin glargine	Insulin degludec	Incremental
Type 1 diabetes	24,712	23,219	−1,493	0.7841	0.7877	+0.0036	Insulin degludec dominant
Type 2 diabetes basal-only	10,117	9,978	−139	0.8209	0.8295	+0.0085	Insulin degludec dominant
Type 2 diabetes basal-bolus	29,655	31,163	+1,508	0.7807	0.7876	+0.0068	221,063

Figure 2. Cost-effectiveness scatterplots for insulin degludec vs insulin glargine in patients with type 1 diabetes on basal-bolus and in patients with type 2 diabetes on basal-only or basal-bolus therapy.

Figure 3. Cost-effectiveness acceptability curves for each analysis over a range of willingness-to-pay values spanning DKK 0–400,000 per QALY gained.

Table 7. One-way sensitivity analysis outcomes.

	Incremental cost-effectiveness ratio (DKK per QALY gained)
	Type 1 diabetes basal-bolus	Type 2 diabetes basal-only	Type 2 diabetesbasal-bolus
Base case	Insulin degludec dominant	Insulin degludec dominant	221,063
No difference in insulin dose	Insulin degludec dominant	60,977	121,299
No difference in daytime non-severe hypoglycemia	Insulin degludec dominant	Insulin degludec dominant	393,886
No difference in nocturnal non-severe hypoglycemia	Less costly, equally effective	Insulin degludec dominant	571,367
No difference in severe hypoglycemia	Insulin degludec dominant	Insulin degludec dominant	221,063
Mortality after severe hypoglycemia	Insulin degludec dominant	Insulin degludec dominant	220,914
Price of biosimilar glargine (DKK 370.28/1500 IUs)	Insulin degludec dominant	62,945	348,944

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