Value For Money In The Treatment Of Patients With Type 2 Diabetes Mellitus: Assessing The Long-Term Cost-Effectiveness Of IDegLira Versus iGlarLixi In Italy
Received 8 June 2019
Accepted for publication 6 September 2019
Published 7 October 2019 Volume 2019:11 Pages 605—614
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Dean Smith
Johannes Pöhlmann,1 Roberta Montagnoli,2 Giusi Lastoria,3 Witesh Parekh,4 Marie Markert,5 Barnaby Hunt1
1Health Economics, Ossian Health Economics and Communications, Basel 4051, Switzerland; 2External Affairs-Region Europe, Novo Nordisk SpA, Rome IT00144, Italy; 3Medical Advice, Novo Nordisk SpA, Rome IT00144, Italy; 4European HEOR, Nova Nordisk Ltd, West Sussex RH6 0PA, UK; 5Global Market Access, Novo Nordisk A/S, Søborg DK-2860, Denmark
Correspondence: Barnaby Hunt
Health Economics, Ossian Health Economics and Communications GmbH, Bäumleingasse 20, Basel CH-4051, Switzerland
Tel +41 61 271 6214
Objective: Italian treatment guidelines for type 2 diabetes mellitus (T2DM) target good glycemic control but acknowledge the associated risk of hypoglycemia. Unlike traditional antidiabetic therapies, modern treatment options such as fixed-ratio combinations of basal insulin and glucagon-like peptide 1 receptor agonists are associated with improved glycemic control, reduced body weight and low risk of hypoglycemia. The cost-effectiveness of the fixed-ratio combinations of basal insulin and glucagon-like peptide 1 receptor agonists IDegLira and iGlarLixi was assessed for Italy in patients with T2DM uncontrolled on basal insulin, to evaluate how short-term clinical benefits translate into long-term health economic outcomes.
Methods: The IQVIA CORE Diabetes Model was used to project clinical and economic outcomes over patient lifetimes. Treatment effects were sourced from an indirect treatment comparison. The analysis captured direct medical costs (expressed in 2017 Euros) from the perspective of the Italian National Health Service (NHS) and patient-related quality of life. Sensitivity analyses were performed.
Results: IDegLira was associated with gains of 0.09 life years and 0.13 quality-adjusted life years (QALYs) relative to iGlarLixi, due to a lower cumulative incidence and delayed onset of diabetes-related complications. IDegLira was associated with an incremental cost of EUR 930 over patient lifetimes, leading to an incremental cost-effectiveness ratio of EUR 7,386 per QALY gained.
Conclusion: Over the lifetime of patients with T2DM uncontrolled on basal insulin, IDegLira was associated with improved clinical outcomes at higher costs relative to iGlarLixi. At a willingness-to-pay threshold of EUR 30,000 per QALY gained, IDegLira was considered to be cost-effective versus iGlarLixi from the perspective of the Italian NHS.
Keywords: cost-effectiveness, fixed-ratio combination, IDegLira, iGlarLixi, Italy, type 2 diabetes
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