Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

Diabetes Therapy pp 1–16 | Cite as Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi AuthorsAuthors and affiliations Johannes PöhlmannMonika Russel-SzymczykPavel HolíkKarel RychnaBarnaby Hunt Open Access Original Research First Online: 31 January 2019 138 Downloads Abstract Introduction Few patients with type 2 diabetes mellitus (T2DM) achieve recommended glycemic control targets in the Czech Republic. Novel therapies, such as fixed-ratio combinations of basal insulin plus glucagon-like peptide-1 receptor agonists, may contribute to better glycemic control. In the analysis presented here, the present analysis assessed the long-term cost-effectiveness of two fixed-ratio combinations, IDegLira (insulin degludec/liraglutide) and iGlarLixi (insulin glargine/lixisenatide), for the treatment of patients with T2DM inadequately controlled with basal insulin from a healthcare payer perspective in the Czech Republic. Methods A cost-effectiveness analysis was performed over patient lifetimes using the IQVIA CORE Diabetes Model. Treatment effects were obtained from an indirect treatment comparison as no head-to-head data for IDegLira versus iGlarLixi are currently available. IDegLira was compared with two iGlarLixi pens (100 U/mL insulin glargine + 33 μg/mL and 50 μg/mL of lixisenatide, respectively). Direct medical costs associated with pharmaceutical interventions, screening and diabetes-related complications were captured. Deterministic and probabilistic sensitivity analyses were performed. Results IDegLira was associated with gains in life expectancy of 0.11 years and in quality-adjusted life expectancy of 0.14 quality-adjusted life-years (QALYs) versus iGlarLixi, due to a lower cumulative incidence and delayed onset of diabetes-related complications. IDegLira was also associated with higher projected costs due to higher acquisition costs; however, these were partially offset by cost savings from avoided complications. IDegLira was associated with incremental cost-effectiveness ratios of Czech Koruna (CZK) 695,998 and CZK 348,323 per QALY gained versus iGlarLixi pens containing 33 and 50 μg/mL of lixisenatide, respectively. These ratios were below the commonly used willingness-to-pay threshold of CZK 1,200,000 per QALY gained. Conclusion The present analysis indicated that IDegLira was associated with clinical benefits relative to iGlarLixi over patient lifetimes and was likely to be cost-effective in the treatment of patients with T2DM uncontrolled on basal insulin in the Czech Republic. Funding Novo Nordisk. Plain Language Summary Plain language summary is available for this article. KeywordsCost-effectiveness Czech Republic Fixed-ratio combination IDegLira iGlarLixi Type 2 diabetes  Enhanced Digital Features To view enhanced digital features for this article go to:  https://doi.org/10.6084/m9.figshare.7583651. Electronic Supplementary Material The online version of this article ( https://doi.org/10.1007/s13300-019-0569-7) contains supplementary material, which is available to authorized users. Plain Language Summary Patients with type 2 diabetes mellitus (T2DM) benefit from reductions in blood sugar levels and body weight, which lower the risk of long-term diabetes-related complications. Novel treatments, such as fixed-ratio combinations (FRCs) of insulin plus glucagon-like peptide-1 receptor agonists, can help patients to achieve these treatment targets, at low risk of hypoglycemia. In the Czech Republic, too few patients with T2DM achieve treatment targets, and diabetes imposes a substantial cost burden on the healthcare system. Modern antidiabetic treatments, such as FRCs (e.g. IDegLira and iGlarLixi), provide the means to improve diabetes treatment and reduce diabetes-related costs. As healthcare budgets are not limitless, healthcare payers need to choose cost-effective treatments to achieve the best possible use of budgets. The present study evaluated the long-term cost-effectiveness of IDegLira versus iGlarLixi in Czech patients with T2DM poorly controlled on basal insulin. A recent network meta-analysis (NMA) comparing IDegLira and iGlarLixi reported reductions in blood sugar levels (measured as glycated hemoglobin) and body weight, as well as lower hypoglycemia rates, for IDegLira relative to iGlarLixi. As no head-to-head studies comparing the two FRCs are available, the NMA is the best source to inform long-term modeling. Relative to iGlarLixi, IDegLira was associated with higher life expectancy and quality-adjusted life expectancy. Over patient lifetimes, the costs of diabetes-related complications were lower in patients treated with IDegLira and partly offset the higher acquisition costs of IDegLira. In the Czech Republic, IDegLira is a cost-effective alternative to iGlarLixi for the treatment of patients with T2DM poorly controlled on basal insulin. Introduction Diabetes is considered a “global pandemic” of the twenty-first century and associated with a substantial clinical and economic burden on patients and healthcare systems [1]. In 2017, it was estimated that 863,106 people in the Czech Republic were living with diagnosed diabetes (patients with impaired glucose tolerance not included), of whom 84% had type 2 diabetes mellitus (T2DM) [2]. Good glycemic control is crucial to reduce the incidence of diabetes-related complications and, consequently, the clinical and economic burden associated with diabetes [3, 4]. In the Czech Republic, lifestyle changes and metformin therapy are recommended as first-line therapy for patients with T2DM [5]. If glycated hemoglobin (HbA1c) levels do not fall below 7.0% within 6 months while on this therapeutic regimen, then intensification to dual therapy with other non-insulin antidiabetic medications (including glucagon-like peptide-1 [GLP-1] receptor agonists) or insulin is recommended. If the HbA1c target is then not reached within another 6 months, treatment with an intensive insulin regimen or combination therapy (of non-insulin antidiabetic medications) is recommended to achieve a target HbA1c level of 7.0% [5]. In the Czech Republic, however, only about one-third of patients with T2DM achieve an HbA1c target of 7.0%, as recently demonstrated in the DIAINFORM study [6]. No measurable improvements in glycemic control were identified over the 3 years prior to the study, and clinical inertia was considered by the authors to be a likely cause for the lack of progress, leading them to call for the use of novel antidiabetic therapies [6]. Fixed-ratio combinations of GLP-1 receptor agonists plus basal insulin represent such novel treatments for patients with T2DM who fail to achieve adequate glycemic control. These combinations could be attractive treatment options as they combine the complementary effects of their components [7, 8]. While basal insulin provides a sta (...truncated)