The online version of this article (https://doi.org/10.1007/s13300-018-0430-4) contains supplementary material, which is available to authorized users.
To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare.6128024.
The aim of this study was to evaluate the short-term cost-utility of insulin degludec (degludec) versus insulin glargine 100 units/mL (glargine U100) for the treatment of type 2 diabetes in the basal–bolus subgroup of the head-to-head cardiovascular (CV) outcome trial, DEVOTE.
A cost-utility analysis was conducted over a 2-year time horizon using a decision analytic model to compare costs in patients receiving once daily degludec or glargine U100, both as part of a basal–bolus regimen, in addition to standard care. Clinical outcomes and patient characteristics were taken exclusively from DEVOTE, whilst health-related quality of life utilities and UK-specific costs (expressed in 2016 GBP) were obtained from the literature. The analysis was conducted from the perspective of the National Health Service.
Degludec was associated with mean cost savings of GBP 28.78 per patient relative to glargine U100 in patients with type 2 diabetes at high CV risk. Cost savings were driven by the reduction in risk of diabetes-related complications with degludec, which offset the higher treatment costs relative to glargine U100. Degludec was associated with a mean improvement of 0.0064 quality-adjusted life-years (QALYs) compared with glargine U100, with improvements driven predominantly by lower rates of severe hypoglycemia with degludec versus glargine U100. Improvements in quality-adjusted life expectancy combined with cost neutrality resulted in degludec being dominant over glargine U100. Sensitivity analyses demonstrated that the incremental cost-utility ratio was stable to variations in the majority of model inputs.
The present short-term modeling analysis found that for the basal–bolus subgroup of patients in DEVOTE, with a high risk of CV events, degludec was cost neutral (no additional costs) compared with glargine U100 over a 2-year time horizon in the UK setting. Furthermore, there were QALY gains with degludec, particularly due to the reduction in the risk of severe hypoglycemia.
Novo Nordisk A/S.
ClinicalTrials.gov identifier, NCT01959529.
Supplementary material 1 (DOCX 190 kb)13300_2018_430_MOESM1_ESM.docx
NCD Risk Factor Collaboration. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387:1513–30. CrossRef
International Diabetes Federation. IDF diabetes atlas. Brussels: IDF; 2017.
Kanavos P, Van den Aardweg S, Schurer W. Diabetes expenditure, burden of disease and management in 5 EU countries. London: London School of Economics; 2012.
Holbrook T, Tang Y, Das R, et al. Direct medical costs of severe hypoglycaemic events in patients with type 2 diabetes in England: a retrospective database study. Int J Clin Pract. 2017;71:e12958. CrossRef
Leiter LA, Yale JF, Chiasson J-L, Harris SB, Kleinstiver P, Sauriol L. Assessment of the impact of fear of hypoglycemic episodes on glycemic and hypoglycemic management. Can J Diabetes. 2005;29:186–92.
Bloomfield HE, Greer N, Newman D, et al. Predictors and consequences of severe hypoglycemia in adults with diabetes—a systematic review of the evidence. VA-ESP Project #09-009. Washington, DC: Department of Veterans Affairs; 2012.
Heise T, Kaplan K, Haahr HL. Day-to-day and within-day variability in glucose-lowering effect between insulin degludec and insulin glargine (100 U/mL and 300 U/mL): a comparison across studies. J Diabetes Sci Technol. 2018;12(2):356–63.
American Diabetes Association. Standards of medical care in diabetes 2017. Diabetes Care. 2017;40:S64–74. CrossRef
Meneghini L, Mersebach H, Kumar S, Svendsen AL, Hermansen K. Comparison of 2 intensification regimens with rapid-acting insulin aspart in type 2 diabetes mellitus inadequately controlled by once-daily insulin detemir and oral antidiabetes drugs: the step-wise randomized study. Endocr Pract. 2011;17:727–36. CrossRefPubMed
Barendse S, Singh H, Frier BM, Speight J. The impact of hypoglycaemia on quality of life and related patient-reported outcomes in type 2 diabetes: a narrative review. Diabet Med. 2012;29:293–302.
National Institute for Health and Care Excellence. NICE process and methods guides. Guide to the methods of technology appraisal. 2013. Available at: https://www.nice.org.uk/process/pmg9/chapter/the-reference-case. Accessed November 2017.
MIMS. MIMS monthly index of medical specialities. 2017. Available at: https://www.mims.co.uk/. Accessed October 2017.
Personal Social Services Research Unit. The hospital and community health services index. 2016. Available at: http://www.pssru.ac.uk/pub/uc/uc2016/sources-of-information.pdf. Accessed October 2017.
Palmer AJ, Roze S, Valentine WJ, et al. The CORE diabetes model: projecting long-term clinical outcomes, costs and cost-effectiveness of interventions in diabetes mellitus (types 1 and 2) to support clinical and reimbursement decision-making. Curr Med Res Opin. 2004;20(Suppl 1):S5–26. CrossRefPubMed
Waugh N, Cummins E, Royle P, et al. Newer agents for blood glucose control in type 2 diabetes: systematic review and economic evaluation. Health Technol Assess. 2010;14:1–248. PubMed
Nicolucci A, Kovacs Burns K, Holt RI, et al. Diabetes Attitudes, Wishes and Needs second study (DAWN2): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med. 2013;30:767–77.
- DEVOTE 5: Evaluating the Short-Term Cost-Utility of Insulin Degludec Versus Insulin Glargine U100 in Basal–Bolus Regimens for Type 2 Diabetes in the UK
Richard F. Pollock
William J. Valentine
Steven P. Marso
Lars L. Hansen
John B. Buse
On behalf of the DEVOTE Study Group
- Springer Healthcare
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II