Background: Understanding which therapeutic innovations in diabetes represent the best value requires rigorous economic evaluation. Data from randomised controlled trials and observational studies indicate that insulin degludec has a hypoglycemia advantage versus insulin glargine 100 units/mL (glargine U100), the most widely prescribed basal insulin analogue in the UK. This analysis was done to more rigorously assess cost-effectiveness in a UK setting.
Methods: Data from two double-blinded, randomised, two-period crossover trials in type 1 (SWITCH 1) and type 2 (SWITCH 2) diabetes mellitus were used to assess the cost-effectiveness of degludec vs. glargine U100 with an economic model. Cost-effectiveness was analysed over a 1-year time horizon based on the different rates of hypoglycaemia and actual doses of insulin used, rather than glycaemic control due to the treat-to-target trial design.
Results: In type 1 diabetes mellitus, degludec was highly cost-effective compared with glargine U100, with an incremental cost-effectiveness ratio of £984 (increased costs of only £23/year and improvement in participant health of 0.0232 quality-adjusted life-years (QALYs)). In type 2 diabetes mellitus, it was estimated that quality of life was improved (0.0065 QALYs gain) with degludec compared with glargine U100 at an increased annual cost of £117 (incremental cost-effectiveness ratio, £17,939). One-way sensitivity analyses showed that the results were robust to changes in parameters in both type 1 and type 2 diabetes mellitus.
Conclusions: The rigorous design of the SWITCH trials, coupled with a representative patient population and a definition of hypoglycaemia that is relevant for real-world patients, makes the results of these trials highly generalisable. The within-trial analysis has the added value of being able to include doses and event rates directly from the trials. This short-term economic analysis estimated that IDeg would be cost-effective relative to IGlar U100 in both type 1 and type 2 diabetes mellitus in the UK.
Trial Registration: SWITCH 1 (NCT02034513); SWITCH 2 (NCT02030600).
Funding: Novo Nordisk, Søborg, Denmark.
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| http://dx.doi.org/10.1007/s13300-018-0478-1 | DOI Listing |
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Article Synopsis
- The study aimed to compare the risk of hypoglycemia among type 2 diabetes patients on metformin and adding one of four common therapies: glargine, glimepiride, liraglutide, or sitagliptin.
- The trial included 5,047 participants, assessing severe hypoglycemia events and symptoms over an average of 5 years, with a per-protocol analysis of 4,830 who completed follow-ups.
- Results showed that glimepiride had the highest incidence of severe hypoglycemia (1.3%), while liraglutide and sitagliptin had the lowest risks, indicating varying hypoglycemia likelihood based on the second medication added
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