IDegLira: A Cost-Effective Alternative to Basal-Bolus Therapy in T2D

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Participants assigned to IDegLira had fewer non-severe hypoglycemic events.
Participants assigned to IDegLira had fewer non-severe hypoglycemic events.

According to a study published in Diabetes, Obesity and Metabolism, insulin degludec/liraglutide (IDegLira) is a cost-effective alternative to basal-bolus therapy (insulin glargine U100 plus insulin aspart) for providing glycemic control in the management of type 2 diabetes. IDegLira involves a simpler treatment regimen and was associated with fewer hypoglycemic episodes and reduced weight gain, contributing to better adherence practices and lower clinical costs.

Clinical data were gathered from the treat-to-target DUAL VII trial, which compared the efficacy and safety of IDegLira with basal-bolus therapy. A population of 506 adults with type 2 diabetes and who were unable to successfully control blood glucose levels were included in the study. Inadequate glycemic control was defined as glycated hemoglobin (HbA1c) of ≥ 7.5%. Adjusting differences in baseline characteristics, both therapies were associated with similar HbA1c reductions; however, IDegLira had fewer non-severe hypoglycemic episodes and was associated with a significant reduction in body mass index compared with basal-bolus therapy.

A cost-utility model developed in Microsoft Excel analyzed clinical and economic outcomes of IDegLira and basal-bolus therapy over a 1-year period. Costs included medications, needles, self-monitoring blood glucose testing, and costs of clinical events including hypoglycemic episodes. Outcomes were reported in cost breakdown (in British Pounds [GBP]), quality of life (measured in quality-adjusted life years), and the incremental cost-effectiveness ratio. Disutility values captured differences in severe and non-severe hypoglycemic episodes, weight gain, and injection frequency; these values were then applied to calculate a gain or loss in quality-adjusted life years.

An improvement of 0.05 quality-adjusted life years was awarded to IDegLira due to the treatment regimen's ability to reduce the number of non-severe hypoglycemic episodes and body mass index. Higher costs were associated with IDegLira by 303 GBP per patient, but were offset by cost savings from fewer hypoglycemic episodes, less need for self-monitoring blood glucose, and reduced needle use. The improvement in quality-adjusted life years contributed to an incremental cost-effectiveness ratio of 5,924 GBP per quality-adjusted life year gained for IDegLira vs basal-bolus therapy.

Falling under the willingness-to-pay threshold of GBP 20,000 per quality-adjusted life year, IDegLira was found as a cost-effective alternative to basal-bolus therapy. IDegLira provides a simpler treatment regimen than basal-bolus therapy for individuals with type 2 diabetes who are inadequately controlled on basal insulin. IDegLira should be considered as a viable option for intensifying a long-acting basal insulin regimen in those with inadequate glycemic control in the effective management of type 2 diabetes.

The study was supported by funding from Novo Nordisk A/S.

Reference

Drummond RS, Malkin SJP, Du Preez M, Lee XY, Hunt B. Management of type 2 diabetes with Fixed-Ratio combination insulin degludec/liraglutide (IDegLira) versus Basal-Bolus therapy (insulin glargine U100 plus insulin aspart): A short-term cost-effectiveness analysis in the UK setting [published online May 24, 2018]. Diabetes Obes Metab. doi: 10.1111/dom.13375

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