Short-term cost-utility of degludec versus glargine U100 for patients with type 2 diabetes at high risk of hypoglycaemia and cardiovascular events: A Canadian setting (DEVOTE 9).

Richard F Pollock,Thomas R Pieber,Nino Hallén,Bernard Zinman,Simon Heller,Vincent Woo,Deniz Tutkunkardas,Maria Luckevich,Jens Gundgaard

doi:10.1111/dom.13730

Abstract

AimsTo evaluate the short‐term cost‐effectiveness of insulin degludec (degludec) vs insulin glargine 100 units/mL (glargine U100) from a Canadian public healthcare payer perspective in patients with type 2 diabetes (T2D) who are at high risk of cardiovascular events and hypoglycaemia.Materials and methodsA decision analytic model was developed to estimate costs (2017 Canadian dollars [CAD]) and clinical outcomes (quality‐adjusted life years [QALYs]) with degludec vs glargine U100 over a 2‐year time horizon. The model captured first major adverse cardiovascular event, death, severe hypoglycaemia and insulin dosing. Clinical outcomes were informed by a post hoc subgroup analysis of the DEVOTE trial (NCT01959529), which compared the cardiovascular safety of degludec and glargine U100 in patients with T2D who are at high cardiovascular risk. High hypoglycaemia risk was defined as the top quartile of patients (n = 1887) based on an index of baseline hypoglycaemia risk factors.ResultsIn patients at high hypoglycaemia risk, degludec was associated with mean cost savings (CAD 129 per patient) relative to glargine U100, driven by a lower incidence of non‐fatal myocardial infarction, non‐fatal stroke and severe hypoglycaemia, which offset the slightly higher cost of treatment with degludec. A reduced risk of cardiovascular death and severe hypoglycaemia resulted in improved effectiveness (+0.0132 QALYs) with degludec relative to glargine U100. In sensitivity analyses, changes to the vast majority of model parameters did not materially affect model outcomes.ConclusionOver a 2‐year period, degludec improved clinical outcomes at a lower cost as compared to glargine U100 in patients with T2D at high risk of cardiovascular events and hypoglycaemia.

Highlights

Diabetes is a major global public health concern because of its high prevalence and association with morbidity, mortality and economic burden.[1]
In an additional sensitivity analysis, long-term costs and clinical outcomes with degludec vs glargine insulin glargine 100 units/mL (U100) were simulated over a 50-year time horizon in the IQVIA CORE Diabetes Model version 9.0 (IQVIA, Basel, Switzerland) using cardiovascular risk equations from the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model 2 and parameters detailed in Table S4.36 Cost and effectiveness outcomes, the latter expressed in quality-adjusted life year (QALY), were attached to each of the four scenarios detailed in Figure S2 and did not vary between treatment arms
Our short-term modelling analysis suggested that, from a Canadian public healthcare payer perspective, treatment with degludec over 2 years would be associated with improved quality-adjusted life expectancy at lower cost, as compared to treatment with glargine U100, in patients with type 2 diabetes (T2D) at high risk of hypoglycaemia and cardiovascular events

Summary

| INTRODUCTION

Diabetes is a major global public health concern because of its high prevalence and association with morbidity, mortality and economic burden.[1]. Prior to the DEVOTE trial, CEAs of degludec compared with glargine U100 captured the effects of hypoglycaemia rates and insulin dosing over a short-term (1-year) time horizon in patients with type 1 (T1D) or type 2 (T2D) diabetes, based on the phase 3 clinical trial programme.[18,19,20,21,22,23] The DEVOTE trial provided an opportunity to evaluate randomized, double-blind clinical trial data, including cardiovascular endpoints and death, in addition to severe hypoglycaemia rates and insulin dosing, to provide health economic analyses of degludec vs glargine U100 over a 2-year time horizon without extrapolation. The aim of the present post hoc analysis was to evaluate, from a Canadian public healthcare payer perspective, the short-term costutility of degludec vs glargine U100 in patients with T2D who are at high risk of hypoglycaemia and cardiovascular events

| MATERIALS AND METHODS

| RESULTS

| DISCUSSION

Findings

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