title: Cost Effectiveness of IDegLira vs. Alternative Basal Insulin Intensification Therapies in Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in a UK Setting.
abstract: Once-daily insulin degludec/liraglutide (IDegLira) is the first basal insulin and glucagon like peptide-1 receptor agonist combined in one delivery device. Our aim was to investigate the cost effectiveness of IDegLira vs. basal insulin intensification therapies for patients with type 2 diabetes mellitus uncontrolled on basal insulin (glycosylated haemoglobin; HbA1c >7.5 %; 58 mmol/mol) in a UK setting.
  
  
  
  Baseline cohort and clinical parameters were sourced from a pooled analysis comparing IDegLira with basal insulin plus liraglutide and basal-bolus therapy, and from the DUAL™ V trial comparing IDegLira with up-titrated insulin glargine (IGlar; Lantus(®)). The CORE Diabetes Model simulated lifetime costs and outcomes with IDegLira vs. these comparators from a UK healthcare payers' perspective. All costs were expressed in 2015 GBP. Sensitivity analyses were performed to assess the impact of key parameters in the model.
  
  
  
  Treatment with IDegLira resulted in mean increases in quality-adjusted life-years (QALYs) of 0.12, 0.41 and 0.24 vs. basal insulin plus liraglutide, basal-bolus therapy and up-titrated IGlar, respectively. IDegLira was associated with lower costs of £971 and £1698 vs. basal insulin plus liraglutide and basal-bolus therapy, respectively, and increased costs of £1441 vs. up-titrated IGlar. IDegLira was dominant, i.e., both more effective and less costly vs. basal insulin plus liraglutide and basal-bolus therapy, and highly cost effective vs. up-titrated IGlar with an incremental cost-effectiveness ratio of £6090/QALY gained.
  
  
  
  Once-daily IDegLira may be considered a cost-effective treatment option for prescribers, to improve glycaemic control for type 2 diabetes patients uncontrolled on basal insulin without an increased risk of hypoglycaemia or weight gain, and without adding to their injection burden.
authors.affiliation: Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Davies
authors.affiliation: Novo Nordisk Ltd, 3 City Place, Beehive Ring Road, Gatwick, West Sussex, RH6 0PA, UK. dng@novonordisk.com.
authors.forename: Divina
authors.initials: D
authors.lastname: Glah
authors.affiliation: Novo Nordisk Ltd, 3 City Place, Beehive Ring Road, Gatwick, West Sussex, RH6 0PA, UK.
authors.forename: Barrie
authors.initials: B
authors.lastname: Chubb
authors.affiliation: IMS Health, London, UK.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Konidaris
authors.affiliation: Centre for Health Economics, Swansea University, Swansea, Wales, UK.
authors.forename: Phil
authors.initials: P
authors.lastname: McEwan
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D004338:Drug Combinations; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics; D049528:Insulin, Long-Acting / Q000008:administration & dosage* / Q000191:economics; D061385:Insulins / Q000008:administration & dosage / Q000191:economics; D000069450:Liraglutide / Q000008:administration & dosage* / Q000191:economics; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D006113:United Kingdom
chemical_list: D001786:Blood Glucose; D004338:Drug Combinations; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D061385:Insulins; D000069450:Liraglutide; C000613158:IDegLira