title: Cost-effectiveness of once daily GLP-1 receptor agonist lixisenatide compared to bolus insulin both in combination with basal insulin for the treatment of patients with type 2 diabetes in Norway.
abstract: BACKGROUND
  Lixisenatide is a potent, selective and short-acting once daily prandial glucagon-like peptide-1 receptor agonist which lowers glycohemoglobin and body weight by clinically significant amounts in patients with type 2 diabetes treated with basal insulin, with limited risk of hypoglycemia.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of lixisenatide versus bolus insulin, both in combination with basal insulin, in patients with type 2 diabetes in Norway.
  
  
  METHODS
  The IMS CORE Diabetes Model, a non-product-specific and validated simulation model, was used to make clinical and cost projections. Transition probabilities, risk adjustments and the progression of complication risk factors were derived from the UK Prospective Diabetes Study, supplemented with Norwegian data. Patients were assumed to receive combination treatment with basal insulin, lixisenatide or bolus insulin therapy for 3 years, followed by intensification of a basal-bolus insulin regimen for their remaining lifetime. Simulated healthcare costs, taken from the public payer perspective, were derived from microcosting and diagnosis related groups, discounted at 4% per annum and reported in Norwegian krone (NOK). Productivity costs were also captured based on extractions from the Norwegian Labor and Welfare Administration. Health state utilities were derived from a systematic literature review. Sensitivity and scenario analyses were performed.
  
  
  RESULTS
  Lixisenatide in combination with basal insulin was associated with increased quality-adjusted life years (QALYs) and reduced lifetime healthcare costs compared to bolus insulin in combination with basal insulin in patients with Type 2 diabetes, and can be considered dominant. The net monetary benefit of lixisenatide versus bolus insulin was NOK 39,369 per patient. Results were sensitive to discounting, the application of excess body weight associated disutility and uncertainty surrounding the changes in HbA1c.
  
  
  CONCLUSIONS
  Lixisenatide may be considered an economically efficient therapy in combination with basal insulin in the Norwegian setting, due to cost savings, weight loss and associated gains in health-related quality of life.
authors: a a IMS Health , Stockholm , Sweden.
authors: Pernilla
authors: P
authors: Huetson
authors: b b IMS Health , Basel , Switzerland.
authors: James L
authors: JL
authors: Palmer
authors: c c Sanofi , Norway.
authors: Andrée
authors: A
authors: Levorsen
authors: d d Sanofi , Paris , France.
authors: Marie
authors: M
authors: Fournier
authors: d d Sanofi , Paris , France.
authors: Maeva
authors: M
authors: Germe
authors: e e IMS Health , London , United Kingdom.
authors: Euan
authors: E
authors: McLeod
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D001794:Blood Pressure; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000191:economics; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000191:economics*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009664:Norway; D010455:Peptides / Q000191:economics* / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D000097789:Glucagon-Like Peptide-1 Receptor Agonists; D000067758:Glucagon-Like Peptide-2 Receptor
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008055:Lipids; D010455:Peptides; D000097789:Glucagon-Like Peptide-1 Receptor Agonists; C479460:lixisenatide; D000067758:Glucagon-Like Peptide-2 Receptor
keywords: Cost-effectiveness; Lixisenatide; Modeling; Norway; Type 2 diabetes