Nasal Glucagon Versus Injectable Glucagon for Severe Hypoglycemia: A Cost-Offset and Budget Impact Analysis

Abstract

Background: Severe hypoglycemic events (SHEs) in patients with diabetes are associated with substantial health care costs in the United States (US). Injectable glucagon (IG) is currently available for treatment of severe hypoglycemia but is associated with frequent handling errors. Nasal glucagon (NG) is a novel, easier-to-use treatment that is more often administered successfully. The economic impact of this usability advantage was explored in cost-offset and budget impact analyses for the US setting. Methods: A health economic model was developed to estimate mean costs per SHE for which treatment was attempted using NG or IG, which differed only in the probability of treatment success, based on a published usability study. The budget impact of NG was projected over 2 years for patients with type 1 diabetes (T1D) and type 2 diabetes treated with basal-bolus insulin (T2D-BB). Epidemiologic and cost data were sourced from the literature and/or fee schedules. Results: Mean costs were $992 lower if NG was used compared with IG per SHE for which a user attempted treatment. NG was estimated to reduce SHE-related spending by $1.1 million and $230 000 over 2 years in 10 000 patients each with T1D and T2D-BB, respectively. Reduced spending resulted from reduced professional emergency services utilization as successful treatment was more likely with NG. Conclusions: The usability advantage of NG over IG was projected to reduce SHE-related treatment costs in the US setting. NG has the potential to improve hypoglycemia emergency care and reduce SHE-related treatment costs.

Conversations and Reactions Around Severe Hypoglycaemia (CRASH): Results from the German Cohort of a Global Survey of People with Type 1 Diabetes or Insulin-Treated Type 2 Diabetes and Caregivers

“…This has financial implications: hospital treatment has been identified as a major cost of severe hypoglycaemia management in Germany [32] and is substantially more expensive than treatment by individuals who are not HCPs [33]. It is possible that more widespread and rapid administration of glucagon could lead to reduced emergency services utilisation and hospitalisation and, consequently, reduced costs to the healthcare system [34].…”

Glucagon as a Therapeutic Approach to Severe Hypoglycemia: After 100 Years, Is It Still the Antidote of Insulin?

“…Moreover, a cost-offset and budget impact analysis conducted by Pöhlmann et al in the USA, indicates that nasal glucagon could have the potential to improve hypoglycemia emergency care and reduce SH-related treatment costs [ 114 ].…”

New uses and formulations of glucagon for hypoglycaemia

“…Finally, the use of nasal glucagon as a more effective treatment of severe hypoglycaemia could reduce the use of expensive professional emergency services and the number of hospital admissions, reducing the economic burden of hypoglycaemia 30…”