Comparative pharmacoeconomic evaluation of the treatment of type 2 diabetes mellitus with insulin degludec and insulin glargine in basal-bolus insulin therapy

Alexey S. Kolbin; Marina V. Shestakova; Gagik R. Galstyan; Wenlong Zhao; Anna A. Mosikyan; Aleksey A. Kurylev; Yulia E. Balykina; Maxim A. Proskurin; Yana G. Alekseeva; Elena Y. Startseva

doi:10.14341/probl2017635307-319

Comparative pharmacoeconomic evaluation of the treatment of type 2 diabetes mellitus with insulin degludec and insulin glargine in basal-bolus insulin therapy

https://doi.org/10.14341/probl2017635307-319

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Abstract

Background. Type 2 diabetes mellitus (T2DM) and its complications are the major causes of long-term disability, significant performance loss, and premature mortality. Poor glycemic control, diabetes-related complications, and insulin therapy are associated with a significant increase in diabetes costs. The high cost of insulin analogues restricts reimbursement of their costs in some countries. Comprehensive clinical and economic assessments of different insulin analogues are the useful tool that may help policy-makers to set priorities in medicine provision within the existing system of healthcare funding.

Aim — to compare the clinical and economic effectiveness of insulin degludec (100 U/mL) and insulin glargine (100 U/mL) in basal-bolus therapy for T2DM.

Material and methods. Economic evaluation was based on cost effectiveness analysis (CEA), incremental cost-effectiveness ratio (ICER), cost effectiveness modelling (using 5-year time horizon), sensitivity analysis, and economic feasibility assessment. The clinical effectiveness was evaluated based on changes in the HbA1c level, frequency of severe hypoglycemia, and number of patient-years without complications. Only direct medical costs (costs for insulin therapy and treatment of severe hypoglycemia and diabetes-related complications) were analyzed.

Results. The mean total direct medical costs amounted to 783,789 RUR/patient for degludec (of these, the cost of insulin therapy accounted for 68%) and 730,805 RUR/patient for glargine (of these, the costs for treatment of severe hypoglycemia and diabetes complications accounted for 62.58%). Degludec has a higher efficacy (additional HbA1c reduction by 0.52%), lower rate of severe hypoglycemia, and larger number of complication-free patient-years. Incremental costs (ICER) for degludec amounted to 101,236 RUR/patient (based on a decrease in the HbA1c level) and 353,224 RUR/patient (based on an increase in the number of complication-free patient-years); these values were 14.3- and 4.1-fold lower than the threshold of willingness-to-pay, respectively. Additional analysis of costs in patients with severe hypoglycemia rates of 3 and >3 events/patient/year demonstrated that the estimated mean total costs for insulin degludec were lower by 5 and 23%, respectively, than those for insulin glargine.

Conclusion. Our findings demonstrate the clinical and cost benefits of insulin degludec in T2DM patients, which supports its broader use in routine clinical practice for achieving the best glycemic control with minimal adverse effects.

Keywords

type 2 diabetes mellitus, insulin degludec, evaluation of health technologies, cost-effectiveness, pharmacoeconomic effectiveness

About the Authors

Alexey S. Kolbin

Pavlov First Saint Petersburg State Medical University; Saint Petersburg State University

Russian Federation

MD, PhD, Professor

Competing Interests:

Получал денежное вознаграждение за участие в научно-исследовательских работах с последующей подготовкой отчетов по оценке медицинских технологий; также получал денежное вознаграждение за написание статей и подготовку презентаций по клинико-экономическому анализу для следующих компаний (здесь и далее названия компаний перечислены в алфавитном порядке): «Аллерган», «Амджен», «Астеллас», «Берингер Ингельхайм», «Новартис», «Ново Нордиск», «Пфайзер», «Рош», «Р-фарма», «Санофи-Авентис».

Marina V. Shestakova

Endocrinology Research Centre; I.M. Sechenov First Moscow State Medical University

Russian Federation

MD, PhD, Professor

Competing Interests:

Получала денежное вознаграждение за чтение лекций для компаний «Астра Зенека», «Берингер Ингельхайм», «Мерк Шарп и Доум», «Новартис», «Ново Нордиск», «Санофи-Авентис», «Сервье», принимала участие в консультативных группах «Астра Зенека» и «Ново Нордиск», а также принимала участие в клинических исследованиях, проводимых при поддержке компании «Ново Нордиск».

Gagik R. Galstyan

Endocrinology Research Centre; I.M. Sechenov First Moscow State Medical University

Russian Federation

MD, PhD, Professor

Competing Interests:

Участвовал в консультативных группах «Мерк Шарп и Доум», «Астра Зенека» и «Ново Нордиск», читает лекции для компаний «Берлин Хеми», «Мерк Шарп и Доум», «Новартис», «Ново Нордиск», «Санофи», «Эли Лилли» и а также получал поддержку от БиСи «Фарма» и «Новартис» при проведении научных исследований, а также принимал участие в клинических исследованиях, проводимых при поддержке компаний «Ново Нордиск», «Санофи», «ГлаксоСмит Клян».

Wenlong Zhao

Pavlov First Saint Petersburg State Medical University

Russian Federation

Competing Interests: