title: Cost-effectiveness of insulin degludec compared with insulin glargine for patients with type 2 diabetes treated with basal insulin - from the UK health care cost perspective.
abstract: OBJECTIVE
  The aim of this analysis was to evaluate the cost-effectiveness of insulin degludec (IDeg) versus insulin glargine (IGlar) in adults with type 2 diabetes mellitus (T2DM) who are considered appropriate for treatment with a basal insulin analogue, using a short-term economic model.
  
  
  METHODS
  Meta-analysis data from three phase III clinical studies were used to populate a simple and transparent short-term model. The costs and effects of treatment with IDeg versus IGlar were calculated over a 12-month period. The analysis was conducted from the perspective of the UK National Health Service. Sensitivity analyses were conducted to assess the degree of uncertainty surrounding the results.
  
  
  RESULTS
  IDeg is a cost-effective treatment option versus IGlar in patients with T2DM using basal insulin. Base case incremental cost-effectiveness ratios (ICERs) were estimated at £15,795 per quality-adjusted life-year (QALY) and £13,078 per QALY, which are below commonly accepted thresholds for cost-effectiveness. Sensitivity analyses demonstrated that hypoglycaemia event rates had an important effect on the results. With higher event rates for non-severe hypoglycaemia IDeg was less costly and more effective than IGlar (dominant). Conversely, using lower event rates for severe hypoglycaemia generated higher ICERs. Using hypoglycaemia rates from a subgroup of patients who experienced ≥1 hypoglycaemic event per year IDeg was highly cost-effective versus IGlar; with estimated ICERS of £4887 and £2625 per QALY.
  
  
  CONCLUSIONS
  This short-term modelling approach allows the economic evaluation of newer insulin analogues when advanced long-term modelling based on HbA1c differences is inappropriate. For patients with T2DM who are considered appropriate for treatment with a basal insulin analogue, IDeg is a cost-effective treatment option compared with IGlar and offers additional benefits to subgroups of patients, such as those suffering from recurrent hypoglycaemia.
authors.affiliation: University Hospital Llandough, Cardiff, UK.
authors.forename: M
authors.initials: M
authors.lastname: Evans
authors.forename: M
authors.initials: M
authors.lastname: Wolden
authors.forename: J
authors.initials: J
authors.lastname: Gundgaard
authors.forename: B
authors.initials: B
authors.lastname: Chubb
authors.forename: T
authors.initials: T
authors.lastname: Christensen
mesh_terms: D000328:Adult; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics*; D004334:Drug Administration Schedule; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D007328:Insulin / Q000031:analogs & derivatives*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D008297:Male; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; C571886:insulin degludec
keywords: cost-effectiveness; insulin analogues; insulin therapy; pharmaco-economics; type 2 diabetes