POSC81 Cost-Effectiveness Analysis of Once-Daily Insulin Glargine 300 U/mL (Gla-300) vs Insulin Degludec (IDeg-100) Using the BRAVO Diabetes Model

Abstract

To compare the lifetime cost-effectiveness of once-daily insulin glargine 300 units/mL (Gla-300) versus once-daily insulin degludec 100 units/mL (IDeg-100) in insulin-naïve adults with type 2 diabetes (T2D) inadequately controlled with oral antidiabetic drugs (OADs), including sodium-glucose cotransporter-2, with or without glucagon-like peptide-1 receptor agonists (GLP-1RA). The Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes model was used to assess costs and outcomes with Gla-300 versus IDeg-100 from a US national health payer perspective. Patients were assumed to receive either Gla-300 or IDeg-100 for 5 years, followed by regular insulin therapy for the rest of the 40-year time horizon with 3% annual discounting. Baseline cohort characteristics, changes in physiological parameters and adverse event rates were derived from the 24-week BRIGHT trial (NCT02738151). Costs associated with treatment (based on insulin product net prices and inflated to 2020 USD), complications and utilities were derived from published literature. Outcomes include life-years (LYs), quality-adjusted life-years (QALYs), direct medical costs per person, and the cumulative incidence of diabetes-related complications. Alternative model assumptions were explored through scenario analyses. One-way and probabilistic sensitivity analyses were conducted to assess robustness of Results: Treatment with Gla-300 was associated with an incremental gain of 0.03 LYs and 0.027 QALYs, compared with IDeg-100. Gla-300 resulted in lifetime cost savings of $2250, primarily due to lower insulin costs and fewer diabetes-related complications, with a saving of $488 in the first 5 years. Therefore, Gla-300 was considered dominant versus IDeg-100. At a willingness-to-pay threshold of $50,000/QALY, the probability of Gla-300 being cost-effective was 85%. Multiple scenario and sensitivity analyses confirmed the robustness of base case Results: Compared with IDeg-100, Gla-300 was projected to be cost-effective in treating insulin naïve T2D patients inadequately controlled with OADs (with or without GLP-1RAs) from a US healthcare perspective.