The management of type 2 diabetes with fixed‐ratio combination insulin degludec/liraglutide (IDegLira) versus basal‐bolus therapy (insulin glargine U100 plus insulin aspart): A short‐term cost‐effectiveness analysis in the UK setting

Drummond, Russell; Malkin, Samuel J. P.; Preez, Michelle Du; Lee, Xin Ying; Hunt, Barnaby

doi:10.1111/dom.13375

Cited by 14 publications

(12 citation statements)

References 47 publications

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“…Similar long-term analyses have been conducted in the UK, the Netherlands, Sweden and Slovakia, all of which showed IDegLira to be cost-effective versus basal-bolus insulin and/or basal insulin plus GLP-1 receptor agonists from the perspective of the respective healthcare payer [ 44 – 47 ]. For the UK, a recent short-term CEA also showed that IDegLira was likely to be cost-effective even over 1 year relative to treatment with basal-bolus insulin therapy [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

Pöhlmann¹,

Russel-Szymczyk²,

Holik³

et al. 2019

Diabetes Ther

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Introduction Few patients with type 2 diabetes mellitus (T2DM) achieve recommended glycemic control targets in the Czech Republic. Novel therapies, such as fixed-ratio combinations of basal insulin plus glucagon-like peptide-1 receptor agonists, may contribute to better glycemic control. In the analysis presented here, the present analysis assessed the long-term cost-effectiveness of two fixed-ratio combinations, IDegLira (insulin degludec/liraglutide) and iGlarLixi (insulin glargine/lixisenatide), for the treatment of patients with T2DM inadequately controlled with basal insulin from a healthcare payer perspective in the Czech Republic. Methods A cost-effectiveness analysis was performed over patient lifetimes using the IQVIA CORE Diabetes Model. Treatment effects were obtained from an indirect treatment comparison as no head-to-head data for IDegLira versus iGlarLixi are currently available. IDegLira was compared with two iGlarLixi pens (100 U/mL insulin glargine + 33 μg/mL and 50 μg/mL of lixisenatide, respectively). Direct medical costs associated with pharmaceutical interventions, screening and diabetes-related complications were captured. Deterministic and probabilistic sensitivity analyses were performed. Results IDegLira was associated with gains in life expectancy of 0.11 years and in quality-adjusted life expectancy of 0.14 quality-adjusted life-years (QALYs) versus iGlarLixi, due to a lower cumulative incidence and delayed onset of diabetes-related complications. IDegLira was also associated with higher projected costs due to higher acquisition costs; however, these were partially offset by cost savings from avoided complications. IDegLira was associated with incremental cost-effectiveness ratios of Czech Koruna (CZK) 695,998 and CZK 348,323 per QALY gained versus iGlarLixi pens containing 33 and 50 μg/mL of lixisenatide, respectively. These ratios were below the commonly used willingness-to-pay threshold of CZK 1,200,000 per QALY gained. Conclusion The present analysis indicated that IDegLira was associated with clinical benefits relative to iGlarLixi over patient lifetimes and was likely to be cost-effective in the treatment of patients with T2DM uncontrolled on basal insulin in the Czech Republic. Funding Novo Nordisk. Plain Language Summary Plain language summary is available for this article. Electronic Supplementary Material The online version of this article (10.1007/s13300-019-0569-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

Pöhlmann¹,

Russel-Szymczyk²,

Holik³

et al. 2019

Diabetes Ther

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“…This number is expected to exceed 700 million by 2045 (International Diabetes Federation, 2019), with type 2 diabetes accounting for a large proportion of these patients (Simpson & King, 2015). Type 2 diabetes is a metabolic disease that involves gradual impairment of glucose regulation because of islet β‐cell dysfunction and insulin resistance (Drummond, Malkin, Du Preez, Lee, & Hunt, 2018; Greig & Scott, 2015; Nauck, 2016).…”

Section: Introductionmentioning

confidence: 99%

Simultaneous quantitative determination of liraglutide and insulin degludec in rat plasma by liquid chromatography–tandem mass spectrometry method and its application

Zhai

Dong

et al. 2020

Biomedical Chromatography

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A simple, fast and high‐throughput LC–tandem mass spectrometry method was developed and validated to simultaneously measure liraglutide and insulin degludec in rat plasma. After protein precipitation, plasma samples were subjected to gradient elution using an InertSustain Bio C18 column with 1000/20/1 water/acetonitrile/formic acid (v/v/v) and 1000/1 acetonitrile/formic acid (v/v) as the mobile phase. The method was validated from 1.00 to 500 ng/mL of liraglutide and insulin degludec. Further, the extraction recovery from the plasma was 41.8%–49.2% for liraglutide and 56.5%–69.7% for insulin degludec. Intra‐ and inter‐day precision of liraglutide was 3.5%–9.4% and 8.4%–9.8%, respectively, whereas its accuracy was between −12.6% and −1.3%. Intra‐ and inter‐day precision of insulin degludec was 5.2%–13.6% and 11.8%–19.1%, respectively, showing an accuracy between −3.0% and 9.9%. As a result, the method was successfully applied to a pharmacokinetics study of liraglutide and insulin degludec following a single‐dose subcutaneous administration to rats.

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“…Most studies had a similar bias profile, except double counting and reporting/dissemination had unclear information. Four 35 51 52 57 and 14 studies 21 24 28 30 35 36 49 51 52 54 57 61 66 69 had bias related to model structures and data, respectively. All studies were unclear for internal consistency bias.…”

Section: Resultsmentioning

confidence: 99%

Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies

Bagepally

Chaikledkaew

Gurav

et al. 2020

BMJ Open Diab Res Care

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ObjectivesTo conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure.Research design and methodsThe study design is a systematic review and meta-analysis. We searched MEDLINE (via PubMed), Scopus and Tufts Registry for eligible cost–utility studies up to June 2018, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We conducted a systematic review and pooled the INBs of GLP1s compared with other therapies in T2DM after metformin monotherapy failure. Various monetary units were converted to purchasing power parity, adjusted to 2017 US$. The INBs were calculated and then pooled across studies, stratified by level of country income; a random-effects model was used if heterogeneity was present, and a fixed-effects model if it was absent. Heterogeneity was assessed using Q test and I2 statistic.ResultsA total of 56 studies were eligible, mainly from high-income countries (HICs). The pooled INBs of GLP1s compared with dipeptidyl peptidase-4 inhibitor (DPP4i) (n=10), sulfonylureas (n=6), thiazolidinedione (TZD) (n=3), and insulin (n=23) from HICs were US$4012.21 (95% CI US$−571.43 to US$8595.84, I2=0%), US$3857.34 (95% CI US$−7293.93 to US$15 008.61, I2=45.9%), US$37 577.74 (95% CI US$−649.02 to US$75 804.50, I2=92.4%) and US$14 062.42 (95% CI US$8168.69 to US$19 956.15, I2=86.4%), respectively. GLP1s were statistically significantly cost-effective compared with insulins, but not compared with DPP4i, sulfonylureas, and TZDs. Among GLP1s, liraglutide was more cost-effective compared with lixisenatide, but not compared with exenatide, with corresponding pooled INBs of US$4555.09 (95% CI US$3992.60 to US$5117.59, I2=0) and US$728.46 (95% CI US$−1436.14 to US$2893.07, I2=0), respectively.ConclusionGLP1 agonists are a cost-effective choice compared with insulins, but not compared with DPP4i, sulfonylureas and TZDs.PROSPERO registration numberCRD42018105193.

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The management of type 2 diabetes with fixed‐ratio combination insulin degludec/liraglutide (IDegLira) versus basal‐bolus therapy (insulin glargine U100 plus insulin aspart): A short‐term cost‐effectiveness analysis in the UK setting

Cited by 14 publications

References 47 publications

Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

Simultaneous quantitative determination of liraglutide and insulin degludec in rat plasma by liquid chromatography–tandem mass spectrometry method and its application

Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies

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