title: Budget impact of treating commercially insured type 1 and type 2 diabetes patients in the United States with insulin degludec compared to insulin glargine.
abstract: To quantify the annual budget impact if all US commercially insured type 1 diabetes mellitus patients on basal-bolus therapy (T1DMBBT), type 2 diabetes mellitus patients on basal-oral therapy (T2DMBOT), and type 2 diabetes mellitus patients on basal-bolus therapy (T2DMBBT) switched from insulin glargine (IGlar) to insulin degludec (IDeg).
  
  
  
  A short-term (1 year) budget impact model was developed to evaluate the costs of IDeg vs. IGlar in three treatment groups (T1DMBBT, insulin-naïve T2DMBOT, and T2DMBBT) through a simulation for a potential US health plan population of 35 million. The analysis captured direct medical costs associated with insulin treatment (insulin, needles, and self-monitored glucose testing) and costs related to managing hypoglycemic episodes. There were a total of 59,780 T1DMBBTpatients, 383,145 T2DMBOTpatients, and 171,325 T2DMBBTpatients expected to be using long-acting insulin. A sensitivity analysis on the entire US population was also conducted.
  
  
  
  Among T1DMBBTpatients, IDeg was associated with an annual cost savings of -$357.13 per patient per year (PPPY), driven primarily by reduced insulin utilization. IDeg was also found to be cost saving among T2DMBOTpatients (-$1206.61 PPPY), driven primarily by reductions in the cost of treating severe hypoglycemic episodes. Among T2DMBBTpatients, IDeg was associated with an additional cost to the plan of $1420.04 PPPY; however, this result was driven by a higher insulin dose for IDeg compared to IGlar. Overall, IDeg demonstrated cost savings of $240 million per year, which accounted for total cost savings of 3.5% vs. IGlar.
  
  
  
  The results of this analysis suggest that the reduced insulin utilization and fewer hypoglycemic episodes associated with IDeg may translate into reduced costs for payers. The model is limited by simplification of a complex disease state and assumptions surrounding disease state, treatment patterns, and costs. Therefore, results may not accurately reflect actual health plans or real-world practice patterns.
authors.affiliation: a Novo Nordisk Inc. , Plainsboro , NJ, USA.
authors.forename: James
authors.initials: J
authors.lastname: Weatherall
authors.affiliation: b Xcenda LLC , Palm Harbor , FL, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bloudek
authors.affiliation: a Novo Nordisk Inc. , Plainsboro , NJ, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Buchs
mesh_terms: D002017:Budgets; D017046:Cost Savings; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000069036:Insulin Glargine / Q000008:administration & dosage*; D049528:Insulin, Long-Acting / Q000008:administration & dosage*; D009339:Needles; D014481:United States
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; C571886:insulin degludec
keywords: Budget impact; diabetes mellitus; economic model; insulin degludec; insulin glargine; long-acting insulin