Abstract
BackgroundThis analysis evaluates the cost-effectiveness of insulin degludec (degludec) versus biosimilar insulin glargine U100 (glargine U100) in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in Bulgaria.MethodsA simple, short-term model was used to compare the treatment costs and outcomes associated with hypoglycaemic events with degludec versus glargine U100 in patients with T1DM and T2DM from the perspective of the Bulgarian National Health Insurance Fund. Cost-effectiveness was analysed over a 1-year time horizon using data from clinical trials. The incremental cost-effectiveness ratio (ICER) was the main outcome measure.ResultsIn Bulgaria, degludec was highly cost-effective versus glargine U100 in people with T1DM and T2DM. The ICERs were estimated to be 4493.68 BGN/quality-adjusted life year (QALY) in T1DM, 399.11 BGN/QALY in T2DM on basal oral therapy (T2DMBOT) and 7365.22 BGN/QALY in T2DM on basal bolus therapy (T2DMB/B), which are below the cost-effectiveness threshold of 39,619 BGN in Bulgaria. Degludec was associated with higher insulin costs in all three patient groups; however, savings from a reduction in hypoglycaemic events with degludec versus glargine U100 partially offset these costs. Sensitivity analysis demonstrated that the results were robust and largely insensitive to variations in input parameters. At a willingness-to-pay threshold of 39,619 BGN/QALY, the probability of degludec being cost-effective versus glargine U100 was 60.0% in T1DM, 99.4% in T2DMBOT and 91.3% in T2DMB/B.ConclusionDegludec is a cost-effective alternative to biosimilar glargine U100 for patients with T1DM and T2DM in Bulgaria. Degludec could be of particular benefit to those patients suffering recurrent hypoglycaemia and those who require additional flexibility in the dosing of insulin.
Highlights
This analysis evaluates the cost-effectiveness of insulin degludec versus biosimilar insulin glargine U100 in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in Bulgaria
For the current cost-effectiveness analysis, a simple model with a 1-year time horizon model was developed in Microsoft® Excel 2010 (Microsoft Corp., Redmond, WA, US) to capture the direct medical costs associated with insulin treatment and hypoglycaemia (Fig. 1)
Total costs were 69.37 Bulgarian LEV (BGN) higher (2.3% higher) in the degludec group than the glargine U100 group, which is due to the increased insulin costs with degludec, partially offset (47.19 BGN) by lower costs of hypoglycaemia due to a significantly lower rate of non-severe nocturnal hypoglycaemia versus glargine U100
Summary
This analysis evaluates the cost-effectiveness of insulin degludec (degludec) versus biosimilar insulin glargine U100 (glargine U100) in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in Bulgaria. An estimated 425 people aged 20–79 years worldwide had diabetes in 2017 with an associated healthcare expenditure of approximately $727 billion [1]. This is projected to reach $776 billion by 2045. The Bulgarian Society of Endocrinology recommends the use of intensive insulin therapy with a basal-bolus regimen for people with T1DM [7]. Type 2 diabetes (T2DM) is a Russel-Szymczyk et al BMC Endocrine Disorders (2019) 19:132 progressive disease and glycaemic control can initially be achieved with the use of other antihyperglycaemic agents, a large proportion of people will eventually require insulin to achieve glycaemic targets [8]. Weight gain and restrictive treatment regimens are key impediments to insulin use [19]
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