Evaluation of the long-term cost-effectiveness of IDegLira versus liraglutide added to basal insulin for patients with type 2 diabetes failing to achieve glycemic control on basal insulin in the USA

Figures & data

Table 1. Treatment effects applied in the first year of the analysis.

	IdegLira (mean (SD))	Liraglutide added to basalinsulin (mean (SD))
HbA1c (%)	−1.68 (0.94)	−1.33 (0.94)^a
Systolic blood pressure (mmHg)	−6.84 (12.95)	−4.68 (12.95)
Total cholesterol (mg/dL)	−10.44 (29.67)	−13.26 (29.67)
HDL cholesterol (mg/dL)	+0.47 (6.74)	−0.74 (6.74)
LDL cholesterol (mg/dL)	−7.56 (24.07)	−9.86 (24.07)
Triglycerides (mg/dL)	−18.61 (78.66)	−16.56 (78.66)
Body mass index (kg/m^2)	−1.02 (1.21)	−1.27 (1.21)
Severe hypoglycemic event rate (events per 100 patient years)	0.42	0.00
Non-severe hypoglycemic event rate (events per 100 patient years)	121.88	124.08

HbA1c: glycated hemoglobin; HDL: high density lipoprotein; LDL: low density lipoprotein.

^a Statistically significant difference at 95% confidence level.

Table 2. Annual treatment costs.

	IDegLira ($)	Liraglutide added tobasal insulin ($)
Daily IDegLira cost	24.02	–
Daily basal insulin cost	–	9.60
Daily liraglutide cost	–	24.92
Daily needle costs	0.46	0.88
Daily SMBG cost	1.63	1.63
Total daily cost	26.11	37.04
Total annual cost	9,537.52	13,527.53

$: 2015 US dollars; SMBG: self-monitoring of blood glucose.

Table 3. Long-term cost-effectiveness outcomes.

	IDegLira (Mean (SD))	Liraglutide added tobasal insulin (Mean (SD))	Difference
Discounted life expectancy (years)	14.04 (0.20)	14.02 (0.21)	+0.02
Discounted quality-adjusted life expectancy (QALYs)	8.94 (0.13)	8.91 (0.14)	+0.03
Discounted direct costs ($)	206,385 (2,924)	223,072 (3,055)	–17,687
ICER (life expectancy)	IDegLira dominant
ICER (quality-adjusted life expectancy)	IDegLira dominant

$: 2015 US dollars; ICER: incremental cost-effectiveness ratio; QALYs: quality-adjusted life years; SD: standard deviation.

Figure 1. Mean direct costs over patient lifetimes. $: 2015 US dollars.

Table 4. IDegLira vs liraglutide added to basal insulin: Sensitivity analyses.

	Discounted quality-adjusted life expectancy (QALYs)			Discounted costs ($)			ICER ($ per QALY gained)
	IDegLira	Liraglutide addedto basal insulin	Difference	IDegLira	Liraglutide addedto basal insulin	Difference
Base case	8.94	8.91	+0.03	206,385	224,072	−17,687	IDegLira dominant
20 year time horizon	7.76	7.71	+0.05	168,359	186,026	−17,666	IDegLira dominant
10 year time horizon	5.21	5.19	+0.02	99,781	117,567	−17,786	IDegLira dominant
0% discount rates	12.62	12.57	+0.06	309,213	328,422	−19,209	IDegLira dominant
6% discount rates	6.76	6.74	+0.02	148,088	164,402	−16,314	IDegLira dominant
HbA1c difference abolished	8.91	8.91	0.00	206,520	224,072	−17,552	IDegLira equally effective, but less costly
Blood pressure difference abolished	8.93	8.91	+0.02	206,055	224,072	−18,018	IDegLira dominant
Lipid difference abolished	8.94	8.91	+0.03	206,141	224,072	−17,932	IDegLira dominant
BMI difference abolished	8.95	8.91	+0.04	206,560	224,072	−17,512	IDegLira dominant
Hypoglycemia difference abolished	8.96	8.91	+0.05	206,330	224,072	−17,742	IDegLira dominant
Statistically significant differences only	8.96	8.91	+0.05	206,447	224,072	−17,625	IDegLira dominant
HbA1c benefit maintained	9.03	8.91	+0.12	206,468	224,072	−17,605	IDegLira dominant
UKPDS HbA1c creep	8.45	8.40	+0.05	205,189	222,613	−17,425	IDegLira dominant
Upper 95% CI of HbA1c change in IDegLira arm	8.97	8.91	+0.06	206,596	224,072	−17,476	IDegLira dominant
Lower 95% CI of HbA1c change in IDegLira arm	8.91	8.91	0.00	205,926	224,072	−18,146	IDegLira equally effective, but less costly
BMI benefit maintained after treatment switch	8.93	8.91	+0.02	206,415	224,072	−17,658	IDegLira dominant
Treatment switching at 3 years in both arms	8.86	8.82	+0.04	213,815	224,628	−10,813	IDegLira dominant
Treatment switching at 7 years in both arms	9.05	8.99	+0.06	199,974	223,415	−23,441	IDegLira dominant
No switching	9.52	9.37	+0.15	161,077	218,816	−57,739	IDegLira dominant
Costs of complications +10%	8.94	8.91	+0.03	208,451	226,172	−17,721	IDegLira dominant
Costs of complications −10%	8.94	8.91	+0.03	204,370	222,023	−17,653	IDegLira dominant
Currie et al.^39 hypo utilities applied	9.04	9.01	+0.04	206,385	224,072	−17,687	IDegLira dominant
28% of basal insulin patients twice daily	8.94	8.91	+0.03	206,802	224,678	−17,876	IDegLira dominant
Needle and SMBG costs not included	8.94	8.91	+0.03	185,111	202,158	−17,048	IDegLira dominant
NPH cost applied in liraglutide added to basal insulin arm	8.94	8.91	+0.03	180,724	191,109	−10,384	IDegLira dominant
UKPDS 82 equations applied	9.44	9.41	+0.04	221,237	239,114	−17,877	IDegLira dominant
Version 9.0 of the IMS CORE Diabetes Model	8.88	8.81	+0.07	209,962	227,071	−17,109	IDegLira dominant
PSA	8.62	8.56	+0.06	200,115	216,963	−16,848	IDegLira dominant

$: 2015 United States dollars; BMI: body mass index; CI: confidence interval; HbA1c: glycated hemoglobin; NPH: neutral protamine Hagedorn; PSA: probabilistic sensitivity analysis; QALY: quality-adjusted life year; SMBG: self-monitoring of blood glucose; UKPDS: United Kingdom Prospective Diabetes Study.

Currie CJ, Morgan CL, Poole CD, et al. Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes. Curr Med Res Opin 2006;22:1523-34

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