Cost of achieving HbA1c and weight loss treatment targets with IDegLira vs insulin glargine U100 plus insulin aspart in the USA

Figures & data

Table 1 Percentage of patients achieving treatment targets

	IDegLira (n=252)	Insulin glargine U100 plus insulin aspart (n=253)	OR (95% CI)	P-value
HbA1c <7.0%	66.0	67.0	0.91 (0.62–1.33)	0.6207
HbA1c <7.0% without weight gain	43.3	15.5	4.46 (2.89–6.89)	<0.001
HbA1c <7.0% without hypoglycemia during last 12 weeks of treatment	57.6	33.5	2.58 (1.78–3.74)	<0.001
HbA1c <7.0% without hypoglycemia during 26 weeks of treatment	52.9	23.2	3.40 (2.31–5.01)	<0.001
HbA1c <7.0% without weight gain and hypoglycemia during last 12 weeks of treatment	38.2	6.4	10.39 (5.76–18.75)	<0.001
HbA1c <7.0% without weight gain and hypoglycemia during 26 weeks of treatment	34.9	4.7	12.56 (6.46–24.45)	<0.001
HbA1c ≤6.5%	49.6	44.6	1.26 (0.88–1.82)	0.2116
HbA1c ≤6.5% without weight gain	31.9	10.7	4.15 (2.52–6.84)	<0.001
HbA1c ≤6.5% without hypoglycemia during last 12 weeks of treatment	44.1	24.9	2.59 (1.73–3.87)	<0.001
HbA1c ≤6.5% without hypoglycemia during 26 weeks of treatment	41.2	15.5	4.13 (2.64–6.44)	<0.001
HbA1c ≤6.5% without weight gain and hypoglycemia during last 12 weeks of treatment	28.6	4.7	9.23 (4.68–18.20)	<0.001
HbA1c ≤6.5% without weight gain and hypoglycemia during 26 weeks of treatment	26.9	3.4	11.76 (5.44–25.40)	<0.001

Notes: Hypoglycemia was defined as treatment-emergent severe or blood-glucose confirmed symptomatic hypoglycemic events.

Table 2 Example cost of control calculation

	Drug A	Drug B	Interpretation
Annual treatment cost ($)	11,250.00	9,750.00	Drug A is more costly than drug B
Drug efficacy (% of patients achieving control)	75.00	50.00	Drug A is more effective than drug B in terms of bringing patients to target
Cost per patient achieving control ($)	11,250.00/75.00×100 =15,000.00	9,750.00/50.00×100 =19,500.00	The cost of control is lower with drug A than with drug B
Amount spent to achieve target with drug B relative to $1 spent on drug A	15,000.00/15,000.00 =1.00	19,500.00/15,000.00 =1.30	For every $1 spent on drug A, $1.30 must be spent on drug B to bring one patient to control

Note: Costs are given in 2017 US dollars ($).

Table 3 Annual treatment costs

	IDegLira ($)	Insulin glargine U100 plus insulin aspart ($)
Annual drug cost	9,297.90	8,964.82
Annual needle cost	172.51	670.67
Annual SMBG cost	596.70	1,109.95
Total annual cost	10,067.10	10,745.44

Notes: Costs are given in 2017 US dollars ($). Wholesale acquisition costs were taken from Medi-Span Price Rx and used to calculate the presented annual costs³¹ (base case: IDegLira $953.18 per 1,500 U, insulin glargine $372.76 per 1,500 U, insulin aspart $532.22 per 1,500 U, NovoFine needles $47.23 per 100 needles, UltraFine Nano needles $41.93 per 100 needles; sensitivity analyses: biosimilar insulin glargine U100 $316.85 per 1,500 U, NPH insulin $137.70 per 1,000 U) and annual costs of SMBG testing are taken from Yeaw et al.³²

Abbreviations: NPH, neutral protamine Hagedorn; SMBG, self-monitoring of blood glucose; U, units.

Figure 1 Number needed to treat to bring one patient to target.

Notes: Hypoglycemia was defined as treatment-emergent severe or blood-glucose confirmed symptomatic hypoglycemic events. (A) Number needed to treat to bring one patient to target for single and composite endpoints with HbA1c values <7.0%. (B) Number needed to treat to bring one patient to target for single and composite endpoints with HbA1c values ≤6.5%.

Figure 2 Cost of control.

Notes: Costs are given in 2017 US dollars ($). Hypoglycemia was defined as treatment-emergent severe or blood-glucose confirmed symptomatic hypoglycemic events. (A) Cost of control for single and composite endpoints with HbA1c values <7.0%. (B) Cost of control for single and composite endpoints with HbA1c values ≤6.5%.

Table 4 Sensitivity analysis results: difference in cost of control for IDegLira vs insulin glargine U100 plus insulin aspart

A
	HbA1c <7.0%	HbA1c <7.0% without weight gain	HbA1c <7.0% without hypoglycemia during last 12 weeks of treatment	HbA1c <7.0% without hypoglycemia during 26 weeks of treatment	HbA1c <7.0% without weight gain and hypoglycemia during last 12 weeks of treatment	HbA1c <7.0% without weight gain and hypoglycemia during 26 weeks of treatment
Base case	−785	−46,076	−14,598	−27,286	−141,544	−199,781
Proportion of patients achieving control +10%	−863	−50,683	−16,058	−30,015	−155,698	−219,759
Proportion of patients achieving control −10%	−706	−41,468	−13,139	−24,558	−127,389	−179,803
IDegLira, insulin glargine U100 and insulin aspart pack prices +10%	−714	−49,712	−15,660	−29,393	−153,117	−216,191
IDegLira, insulin glargine U100 and insulin aspart pack prices −10%	−856	−42,439	−13,536	−25,180	−129,970	−183,371
Needle pack prices +10%	−859	−46,469	−14,769	−27,543	−142,547	−201,158
Needle pack prices −10%	−711	−45,683	−14,428	−27,030	−140,541	−198,403
SMBG costs +10%	−860	−46,654	−14,826	−27,652	−143,122	−201,971
SMBG costs −10%	−710	−45,497	−14,371	−26,920	−139,966	−197,590
Needle and SMBG costs excluded	707	−36,364	−10,618	−21,065	−115,735	−164,099
Biosimilar insulin glargine U100 cost applied	285	−41,451	−12,459	−24,197	−130,344	−184,530
NPH insulin cost applied	2,396	−32,328	−8,238	−18,101	−108,249	−154,443
1 insulin aspart injection per day	−270	−43,850	−13,568	−25,799	−136,153	−192,440
4 insulin aspart injections per day	−1,013	−47,064	−15,055	−27,946	−143,937	−203,039
Costs of hypoglycemic events included	−882	−46,569	−14,815	−27,609	−142,791	−201,491
Outcomes based on 6 months of treatment	−392	−23,038	−7,299	−13,643	−70,772	−99,890
B
	HbA1c ≤6.5%	HbA1c ≤6.5% without weight gain	HbA1c ≤6.5% without hypoglycemia during last 12 weeks of treatment	HbA1c ≤6.5% without hypoglycemia during 26 weeks of treatment	HbA1c ≤6.5% without weight gain and hypoglycemia during last 12 weeks of treatment	HbA1c ≤6.5% without weight gain and hypoglycemia during 26 weeks of treatment
Base case	−3,796	−68,866	−20,326	−44,891	−193,427	−278,618
Proportion of patients achieving control +10%	−4,176	−75,753	−22,359	−49,380	−212,769	−306,480
Proportion of patients achieving control −10%	−3,417	−61,980	−18,294	−40,402	−174,084	−250,756
IDegLira, insulin glargine U100 and insulin aspart pack prices +10%	−3,932	−74,330	−21,818	−48,418	−209,250	−301,529
IDegLira, insulin glargine U100 and insulin aspart pack prices −10%	−3,661	−63,403	−18,835	−41,364	−177,604	−255,708
Needle pack prices +10%	−3,912	−69,439	−20,557	−45,282	−194,793	−280,527
Needle pack prices −10%	−3,681	−68,294	−20,096	−44,500	−192,060	−276,710
SMBG costs +10%	−3,925	−69,717	−20,637	−45,462	−195,580	−281,661
SMBG costs −10%	−3,668	−68,016	−20,016	−44,319	−191,274	−275,576
Needle and SMBG costs excluded	−1,355	−54,636	−14,920	−35,270	−158,231	−229,107
Biosimilar insulin glargine U100 cost applied	−2,189	−62,167	−17,448	−40,266	−178,176	−257,536
NPH insulin cost applied	981	−48,952	−11,769	−31,143	−148,089	−215,946
1 insulin aspart injection per day	−3,023	−65,642	−18,941	−42,665	−186,086	−268,471
4 insulin aspart injections per day	−4,140	−70,298	−20,942	−45,879	−196,685	−283,123
Costs of hypoglycemic events included	−3,946	−69,584	−20,619	−45,382	−195,126	−280,986
Outcomes based on 6 months of treatment	−1,898	−34,433	−10,163	−22,445	−96,713	−139,309

Notes: Costs are given in 2017 US dollars ($). Hypoglycemia was defined as treatment-emergent severe or blood-glucose confirmed symptomatic hypoglycemic events. (A) Cost of control for single and composite endpoints with HbA1c values <7.0%. (B) Cost of control for single and composite endpoints with HbA1c values ≤6.5%.

Abbreviations: NPH, neutral protamine Hagedorn; SMBG, self-monitoring of blood glucose.

Medi-Span Price Rx Available from: http://www.wolterskluwercdi.com/price-rx/Accessed August 16, 2017

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