Cost-Effectiveness Analysis Of Insulin Degludec Versus Insulin Glargine U100 In Type 1 And Type 2 Diabetes Patients From The Portuguese National Healthcare System Perspective: Evidence From The Switch 1&2 Trials

• Published in: Value in health Vol. 20; no. 9; p. A481
• Main Authors: Ramirez de Arellano Serna, A, Darba, J, Tikkanen, C, Conde, V
• Format: Journal Article
• Language: English
• Published: Lawrenceville Elsevier Science Ltd 01.10.2017
• Subjects: Blood; Blood glucose; Clinical trials; Cost analysis; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Dosage; Glucose; Health care; Hypoglycemia; Insulin; Needles; Quality adjusted life years; Robustness; Sensitivity analysis; Type 1 diabetes mellitus; Type 2 diabetes mellitus; Willingness to pay
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.465

OBJECTIVES: SWITCH 1&2 randomised, double-blind, two-period, crossover trials in patients with Type 1 and Type 2 diabetes showed fewer hypoglycemic events with insulin degludec (IDeg) vs insulin glargine U100 (IGlar U100).The current study assessed the cost-effectiveness of IDeg vs IGlar U100 from a Portuguese healthcare perspective, using data from the SWITCH 1&2 trials. METHODS: A short-term cost-effectiveness model was elaborated to calculate effectiveness results for IDeg vs IGlar U100. Hypoglycaemia and insulin dose data from SWITCH 1&2, the costs of insulin, needles, blood glucose tests and hypoglycaemic events in Portugal, and disutilities for different types of hypoglycaemic events have been used to populate the model. Benefits were measured in QALYs. RESULTS: In both trials non-severe nocturnal and severe hypoglycaemic events were significantly lower in favour of IDeg. Non-severe daytime hypoglycemic events did not show any difference in SWITCH 1 trial while in SWITCH 2 trial there were a significant lower number of events in favour of IDeg. End-of-trial basal insulin dose was significantly lower with IDeg vs IGlar U100 while bolus doses inTlDM were similar. IDeg proved to be a cost-effective therapy forTlDM andT2DM showing an incremental cost-effectiveness ratio (ICER) of 7,349.196/QALY and 21,930.20e/QALY, respectively. Both ICERs were lower than the willingness to pay threshold of 30,000e/QALY Sensitivity analyses confirmed the robustness of results. CONCLUSIONS: This cost-effectiveness study demonstrates that IDeg is a cost-effective therapy over IGlar U100 forTlDM and T2DM patients from the perspective of the Portuguese healthcare system.