A ready-to-use liquid glucagon for treatment of severe hypoglycemia demonstrates reduced healthcare payer costs in a budget impact model

Figures & data

Figure 1. Conceptual framework.

Figure 2. Key model parameters.

Table 1. Plan and market assumptions for base case model.

Parameter	Value	Source/notes
Plan size	1 million	Baseline assumption
Prevalence of glucagon candidates:  T1D  T2D on insulin	3.6 per 1,000 18.1 per 1,000	Derived from US census and CDC data^33^,^34; Assumes 23% of T2D patients receive insulin^35
Prevalence of a SHE:  T1D  T2D on insulin	35% 6%	Derived from meta-analysis of T1D studies and T2D studies^36^,^37
Price points:  GEKs  GRP and G-PFS	$233.19 $233.19	Competitor price based on actual payments from claims (Data on file and derived from RedBook list prices and IMS claims. 3 January 2018); Xeris price based on historical company data at time of analysis
Probability of receiving glucagon Rx  T1D  T2D on insulin	14.13% 1.58%	Derived from IMS Health Lifelink data
Market share expansion of GRP and G-PFS  GEKs  No Kit	20% 25%	Index assumptions

Table 2. Clinical and health resource use outcomes from base case analysis.

Parameter	Value	Source/notes
Probability of successful use of kit
GRP and G-PFS	0.99
GEKs	0.31	Derived from clinical data^17^,^18
No kit	0.00
Probability of an ambulance call
GRP and G-PFS	0.75	Index assumptions
GEKs	0.90
No kit	0.90
Probability of an ambulance ER trip
GRP and G-PFS	0.05	Index assumptions
GEKs	0.10
No kit	0.10
Probability of actions after ER Visit:
Inpatient admission	0.25	Ginde et al.^38
Discharge	0.746	Calculation
Death	0.004	Parsaik et al.^39
Probability of actions after inpatient visit:
Discharge	0.996	Parsaik et al.^39
Death	0.004	Calculation

Table 3. Health care costs from base case analysis.

Parameter	Value	Source
Ambulance costs		2018 Medicare fee schedule^40
Transport patient to ER	$595.36
No ER transport	$297.68
ER costs (per day)	$2,838
Inpatient costs (per day)	$6,112
Outpatient follow-up costs (per visit)	$142

Table 4. Key model assumptions.

Future SHEs are not impacted by successful treatment of prior events

Successful use with the GRP and G-PFS is higher than for currently available GEKs

The probabilities for ambulance calls and subsequent ER visits are higher among those who are unsuccessfully administered a GEK

The probabilities for ambulance calls and subsequent ER visits among patients with no kit is equivalent to that of those who were unsuccessfully administered a glucagon product

If the glucagon rescue product is not successfully administered by a caregiver, the ambulance will administer glucagon or dextrose (differences between glucagon and dextrose are not modeled)

Patients do not have contraindications to treatment/s administered by the EMS staff

Unit costs for ambulance transport, ER, hospitalization and outpatient visits are constant and do not depend on successful use of glucagon

Death does not accrue any additional costs

All ED and inpatient visits result in outpatient follow-up

Outpatient follow-up after an ER visit and inpatient hospitalization require equivalent number of visits

Currently available injectable GEKs will not take over any of the no kit market

Table 5. Base case model results for a commercial plan with 1 million covered lives.

Outputs	Before GRP and G-PFS	After GRP and G-PFS
Total annual plan costs for SHEs	$8,952,469	$8,233,092
Annual SHE costs per diabetes patient	$413.03	$379.38
SHE costs per diabetes patient per month	$34.42	$31.61
Annual SHE costs per member	$8.95	$8.22
SHE costs per member per month	$0.75	$0.69
Reduction in annual total plan costs		8.15%

Figure 3. One-way sensitivity analyses evaluating model robustness.

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