title: IDegLira Versus Insulin Glargine U100: A Long-term Cost-effectiveness Analysis in the US Setting.
abstract: BACKGROUND
  Treatment with IDegLira has the potential to improve glycemic control in patients with type 2 diabetes mellitus (T2DM) without the weight gain and with a lower risk of hypoglycemia than with other therapies. The aim of the present analysis was to evaluate the long-term cost-effectiveness of IDegLira versus insulin glargine U100 with re-education and up-titration of the dose for treatment of patients with T2DM failing to achieve glycemic control on basal insulin in the US setting.
  
  
  METHODS
  Data were obtained from the DUAL V randomized controlled trial in which adults with T2DM failing to achieve glycemic targets with insulin glargine U100 were randomly allocated to receive either IDegLira or insulin glargine U100. Long-term projections of clinical outcomes and direct costs were made using the IMS CORE Diabetes Model. Costs were accounted from a healthcare payer perspective. Future costs and clinical benefits were discounted at 3% annually.
  
  
  RESULTS
  IDegLira was associated with improved discounted life expectancy (13.99 [standard deviation 0.19] versus 13.82 [standard deviation 0.20] years) and quality-adjusted life expectancy (9.14 [standard deviation 0.12] versus 8.87 [standard deviation 0.13] quality-adjusted life years [QALYs]) compared to insulin glargine U100. IDegLira was associated with increased direct costs of $16,970, yielding an incremental cost-effectiveness ratio (ICER) of $63,678 per QALY gained versus insulin glargine U100. Sensitivity analyses identified that the key driver of cost-effectiveness was the greater reduction in glycated hemoglobin with IDegLira compared with insulin glargine U100.
  
  
  CONCLUSIONS
  Based on head-to-head clinical trial data, the present analysis suggests that IDegLira is likely to improve long-term clinical outcomes for patients with T2DM not achieving glycemic control on basal insulin compared to re-education and up-titration of the dose of insulin glargine U100, with these improvements coming at an increased cost from a healthcare payer perspective. An ICER within the range described as high care value was calculated, suggesting IDegLira is a cost-effective treatment option in the US.
  
  
  BACKGROUND
  Novo Nordisk A/S and Novo Nordisk Inc.
authors.affiliation: Ossian Health Economics and Communications GmbH, Basel, Switzerland. hunt@ossianconsulting.com.
authors.forename: Barnaby
authors.identifier: http://orcid.org/0000-0001-5420-279X
authors.initials: B
authors.lastname: Hunt
authors.affiliation: Novo Nordisk Inc., Plainsboro, New Jersey, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Mocarski
authors.affiliation: Ossian Health Economics and Communications GmbH, Basel, Switzerland.
authors.forename: William J
authors.initials: WJ
authors.lastname: Valentine
authors.affiliation: Novo Nordisk A/S, Søborg, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Langer
keywords: Basal insulin; Cost; Cost-effectiveness; IDegLira; Insulin glargine U100; Type 2 diabetes mellitus; USA