PDB37 Cost-Effectiveness of Insulin Degludec/Insulin Aspart Twice Daily Versus BASAL-Bolus Full Regimen in Patients with Type 2 Diabetes Mellitus in Algeria

Abstract

While due to the progressive nature of Type 2 Diabetes Mellitus (T2DM), patients usually require treatment intensification, fixed combinations of short and long acting insulin can offer a convenient alternative to Basal-Bolus insulin regimen. The aim of this study was to evaluate the cost-effectiveness of 70% Insulin Degludec / 30% Insulin Aspart co-formulation administered twice daily (IDegAsp BID) versus Basal-Bolus full regimen (IGlar+ IAsp, four injections per day) in Algerian patients treated for T2DM. Data derived from a treat-to-target noninferiority trial, and the BAROMETER real-world nationwide study, were used to populate a simple and transparent short-term cost-effectiveness model (DACE Excel-based model). Costs covered insulin, needles, Self-Monitoring Blood Glucose (SMBG) strips and lancets, healthcare resources utilization and indirect costs associated with hypoglycemia. Effects included disutilities of hypoglycemia, SMBG testing, and BMI gain, as well as mortality risk after severe hypoglycemic event. Costs and effects of IDegAsp BID versus Basal-Bolus full regimen were discounted at 3.5% rate, and compared over a 5-year period. Probabilistic Sensitivity Analysis (PSA) was conducted to assess the degree of uncertainty and robustness of the results obtained. Over a 5-year time horizon, the base-case incremental cost of IDegAsp BID versus Basal-Bolus full regimen was estimated to DZD -53,253.13 (all costs), and DZD -6,866.06 (without indirect costs). Savings were mainly driven by SMBG, needles and hypoglycemia. The incremental effectiveness was 0.289 gained Quality-Adjusted Life Years (QALYs) and 0.020 gained Life Years (LYs). The PSA demonstrated that the probability of IDegAsp BID being cost-effective relative to Basal-Bolus full regimen is 93.9% (all costs), and 93.4% (without indirect costs), assuming a willingness-to-pay threshold of 1,401,649 DZD per QALY (3 times GDP per capita). This study has shown that IDegAsp BID is a cost-effective alternative for treatment of T2DM in Algeria compared with Basal-Bolus full regimen, from both payer and societal perspectives.