Skip to main content
Top
Published in: Diabetes Therapy 4/2016

Open Access 01-12-2016 | Original Research

Cost-Effectiveness of Insulin Degludec/Insulin Aspart Versus Biphasic Insulin Aspart in Patients with Type 2 Diabetes from a Danish Health-Care Perspective

Authors: Marc Evans, Jens Gundgaard, Brian Bekker Hansen

Published in: Diabetes Therapy | Issue 4/2016

Login to get access

Abstract

Introduction

To evaluate the cost-effectiveness of the co-formulation insulin degludec/insulin aspart (IDegAsp) versus biphasic insulin aspart (BIAsp 30), both administered twice daily, in patients with type 2 diabetes mellitus (T2DM), using a short-term cost-effectiveness model.

Methods

Data from two phase 3a treat-to-target clinical trials were used to populate a simple and transparent short-term cost-effectiveness model. The costs and effects of treatment with IDegAsp versus BIAsp 30 were calculated over a 5-year period, from a Danish health-care cost perspective. One-way and probabilistic sensitivity analyses were conducted to assess the degree of uncertainty and robustness of the results.

Results

The base-case incremental cost-effectiveness ratio (ICER) of 81,507.91 Danish Kroner (DKK) per quality-adjusted life year (QALY) demonstrates that IDegAsp is a cost-effective treatment compared with BIAsp 30, over a 5-year time horizon. One-way sensitivity analyses show that the ICERs remain within an acceptable range when the rates of hypoglycemia, unit cost of hypoglycemia, disutilities of hypoglycemic events, and the time horizon are varied, ranging from 71,012 DKK to 209,446 DKK. The probabilistic sensitivity analysis demonstrates that the probability that IDegAsp is cost-effective relative to BIAsp 30 is 99.50%, assuming a cost-effectiveness threshold of 250,000 DKK per QALY.

Conclusion

This short-term cost-effectiveness model shows that IDegAsp is a cost-effective treatment compared with BIAsp 30 for patients with T2DM. This result is primarily driven by significant reductions in severe hypoglycemia and insulin dose observed with IDegAsp versus BIAsp 30. Sensitivity analyses demonstrate the robustness of these results.

Funding

Novo Nordisk A/S, Søborg, Denmark.
Appendix
Available only for authorised users
Literature
1.
go back to reference Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015;58:429–42.CrossRefPubMed Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015;58:429–42.CrossRefPubMed
2.
go back to reference Brown A, Steel JM, Duncan C, Duncan A, McBain AM. An assessment of the adequacy of suspension of insulin in pen injectors. Diabet Med. 2004;21:604–8.CrossRefPubMed Brown A, Steel JM, Duncan C, Duncan A, McBain AM. An assessment of the adequacy of suspension of insulin in pen injectors. Diabet Med. 2004;21:604–8.CrossRefPubMed
3.
go back to reference Havelund S, Ribel U, Hubalek F, Hoeg-Jensen T, Wahlund PO, Jonassen I. Investigation of the physico-chemical properties that enable co-formulation of basal insulin degludec with fast-acting insulin aspart. Pharm Res. 2015;32:2250–8.CrossRefPubMedPubMedCentral Havelund S, Ribel U, Hubalek F, Hoeg-Jensen T, Wahlund PO, Jonassen I. Investigation of the physico-chemical properties that enable co-formulation of basal insulin degludec with fast-acting insulin aspart. Pharm Res. 2015;32:2250–8.CrossRefPubMedPubMedCentral
4.
go back to reference Heise T, Hermanski L, Nosek L, Feldman A, Rasmussen S, Haahr H. Insulin degludec: four times lower pharmacodynamic variability than insulin glargine under steady-state conditions in type 1 diabetes. Diabetes Obes Metab. 2012;14:859–64.CrossRefPubMed Heise T, Hermanski L, Nosek L, Feldman A, Rasmussen S, Haahr H. Insulin degludec: four times lower pharmacodynamic variability than insulin glargine under steady-state conditions in type 1 diabetes. Diabetes Obes Metab. 2012;14:859–64.CrossRefPubMed
5.
go back to reference Heise T, Nosek L, Bottcher SG, Hastrup H, Haahr H. Ultra-long-acting insulin degludec has a flat and stable glucose-lowering effect in type 2 diabetes. Diabetes Obes Metab. 2012;14:944–50.CrossRefPubMed Heise T, Nosek L, Bottcher SG, Hastrup H, Haahr H. Ultra-long-acting insulin degludec has a flat and stable glucose-lowering effect in type 2 diabetes. Diabetes Obes Metab. 2012;14:944–50.CrossRefPubMed
6.
go back to reference Kaiser P, Maxeiner S, Weise A, et al. Assessment of the mixing efficiency of neutral protamine Hagedorn cartridges. J Diabetes Sci Technol. 2010;4:652–7.CrossRefPubMedPubMedCentral Kaiser P, Maxeiner S, Weise A, et al. Assessment of the mixing efficiency of neutral protamine Hagedorn cartridges. J Diabetes Sci Technol. 2010;4:652–7.CrossRefPubMedPubMedCentral
7.
go back to reference Fulcher GR, Christiansen JS, Bantwal G, et al. Comparison of insulin degludec/insulin aspart and biphasic insulin aspart 30 in uncontrolled, insulin-treated type 2 diabetes: a phase 3a, randomized, treat-to-target trial. Diabetes Care. 2014;37:2084–90.CrossRefPubMed Fulcher GR, Christiansen JS, Bantwal G, et al. Comparison of insulin degludec/insulin aspart and biphasic insulin aspart 30 in uncontrolled, insulin-treated type 2 diabetes: a phase 3a, randomized, treat-to-target trial. Diabetes Care. 2014;37:2084–90.CrossRefPubMed
8.
go back to reference Kaneko S, Chow F, Choi DS, et al. Insulin degludec/insulin aspart versus biphasic insulin aspart 30 in Asian patients with type 2 diabetes inadequately controlled on basal or pre-/self-mixed insulin: a 26-week, randomised, treat-to-target trial. Diabetes Res Clin Pract. 2015;107:139–47.CrossRefPubMed Kaneko S, Chow F, Choi DS, et al. Insulin degludec/insulin aspart versus biphasic insulin aspart 30 in Asian patients with type 2 diabetes inadequately controlled on basal or pre-/self-mixed insulin: a 26-week, randomised, treat-to-target trial. Diabetes Res Clin Pract. 2015;107:139–47.CrossRefPubMed
9.
go back to reference Christiansen JS, Niskanen L, Rasmussen S, Johansen T, Fulcher G. Lower rates of hypoglycemia during maintenance treatment with IDegAsp versus BIAsp 30: a combined analysis of two phase 3a studies in type 2 diabetes. J Diabetes. 2016. doi:10.1111/1753-0407.12355 [epub ahead of print]. Christiansen JS, Niskanen L, Rasmussen S, Johansen T, Fulcher G. Lower rates of hypoglycemia during maintenance treatment with IDegAsp versus BIAsp 30: a combined analysis of two phase 3a studies in type 2 diabetes. J Diabetes. 2016. doi:10.​1111/​1753-0407.​12355 [epub ahead of print].
10.
go back to reference Garber AJ. Treat-to-target trials: uses, interpretation and review of concepts. Diabetes Obes Metab. 2014;16:193–205.CrossRefPubMed Garber AJ. Treat-to-target trials: uses, interpretation and review of concepts. Diabetes Obes Metab. 2014;16:193–205.CrossRefPubMed
12.
go back to reference Evans M, Wolden M, Gundgaard J, Chubb B, Christensen T. Cost-effectiveness of insulin degludec compared with insulin glargine for patients with type 2 diabetes treated with basal insulin—from the UK health care cost perspective. Diabetes Obes Metab. 2014;16:366–75.CrossRefPubMed Evans M, Wolden M, Gundgaard J, Chubb B, Christensen T. Cost-effectiveness of insulin degludec compared with insulin glargine for patients with type 2 diabetes treated with basal insulin—from the UK health care cost perspective. Diabetes Obes Metab. 2014;16:366–75.CrossRefPubMed
13.
go back to reference Evans M, Wolden M, Gundgaard J, Chubb B, Christensen T. Cost-effectiveness of insulin degludec compared with insulin glargine in a basal-bolus regimen in patients with type 1 diabetes mellitus in the UK. J Med Econ. 2015;18:56–68.CrossRefPubMed Evans M, Wolden M, Gundgaard J, Chubb B, Christensen T. Cost-effectiveness of insulin degludec compared with insulin glargine in a basal-bolus regimen in patients with type 1 diabetes mellitus in the UK. J Med Econ. 2015;18:56–68.CrossRefPubMed
14.
go back to reference Ericsson A, Pollock RF, Hunt B, Valentine WJ. Evaluation of the cost-utility of insulin degludec vs insulin glargine in Sweden. J Med Econ. 2013;16:1442–52.CrossRefPubMed Ericsson A, Pollock RF, Hunt B, Valentine WJ. Evaluation of the cost-utility of insulin degludec vs insulin glargine in Sweden. J Med Econ. 2013;16:1442–52.CrossRefPubMed
18.
go back to reference UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007;50:1140–7.CrossRef UK Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007;50:1140–7.CrossRef
19.
go back to reference Elliott L, Fidler C, Ditchfield A, Stissing T. Hypoglycemia event rates: a comparison between real-world data and randomized controlled trial populations in insulin-treated diabetes. Diabetes Ther. 2016;7:45–60.CrossRefPubMedPubMedCentral Elliott L, Fidler C, Ditchfield A, Stissing T. Hypoglycemia event rates: a comparison between real-world data and randomized controlled trial populations in insulin-treated diabetes. Diabetes Ther. 2016;7:45–60.CrossRefPubMedPubMedCentral
20.
go back to reference Henderson JN, Allen KV, Deary IJ, Frier BM. Hypoglycaemia in insulin-treated type 2 diabetes: frequency, symptoms and impaired awareness. Diabet Med. 2003;20:1016–21.CrossRefPubMed Henderson JN, Allen KV, Deary IJ, Frier BM. Hypoglycaemia in insulin-treated type 2 diabetes: frequency, symptoms and impaired awareness. Diabet Med. 2003;20:1016–21.CrossRefPubMed
21.
go back to reference Akram K, Pedersen-Bjergaard U, Borch-Johnsen K, Thorsteinsson B. Frequency and risk factors of severe hypoglycemia in insulin-treated type 2 diabetes: a literature survey. J Diabetes Complicat. 2006;20:402–8.CrossRefPubMed Akram K, Pedersen-Bjergaard U, Borch-Johnsen K, Thorsteinsson B. Frequency and risk factors of severe hypoglycemia in insulin-treated type 2 diabetes: a literature survey. J Diabetes Complicat. 2006;20:402–8.CrossRefPubMed
22.
go back to reference Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabetes Care. 1994;17:697–703.CrossRefPubMed Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabetes Care. 1994;17:697–703.CrossRefPubMed
23.
go back to reference Donnelly LA, Morris AD, Frier BM, et al. Frequency and predictors of hypoglycaemia in type 1 and insulin-treated type 2 diabetes: a population-based study. Diabet Med. 2005;22:749–55.CrossRefPubMed Donnelly LA, Morris AD, Frier BM, et al. Frequency and predictors of hypoglycaemia in type 1 and insulin-treated type 2 diabetes: a population-based study. Diabet Med. 2005;22:749–55.CrossRefPubMed
24.
go back to reference Smith CB, Choudhary P, Pernet A, Hopkins D, Amiel SA. Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit. Diabetes Care. 2009;32:1196–8.CrossRefPubMedPubMedCentral Smith CB, Choudhary P, Pernet A, Hopkins D, Amiel SA. Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes: evidence from a clinical audit. Diabetes Care. 2009;32:1196–8.CrossRefPubMedPubMedCentral
25.
go back to reference Heller SR. Hypoglycaemia: its pathophysiology in insulin treated diabetes and hypoglycaemia unawareness. Br J Diabetes Vasc Dis. 2011;11:6–9.CrossRef Heller SR. Hypoglycaemia: its pathophysiology in insulin treated diabetes and hypoglycaemia unawareness. Br J Diabetes Vasc Dis. 2011;11:6–9.CrossRef
29.
go back to reference Heller SR, Frier BM, Herslov ML, Gundgaard J, Gough SC. Severe hypoglycaemia in adults with insulin-treated diabetes: impact on healthcare resources. Diabet Med. 2016;33:471–7.CrossRefPubMed Heller SR, Frier BM, Herslov ML, Gundgaard J, Gough SC. Severe hypoglycaemia in adults with insulin-treated diabetes: impact on healthcare resources. Diabet Med. 2016;33:471–7.CrossRefPubMed
30.
go back to reference Brod M, Christensen T, Thomsen TL, Bushnell DM. The impact of non-severe hypoglycemic events on work productivity and diabetes management. Value Health. 2011;14:665–71.CrossRefPubMed Brod M, Christensen T, Thomsen TL, Bushnell DM. The impact of non-severe hypoglycemic events on work productivity and diabetes management. Value Health. 2011;14:665–71.CrossRefPubMed
31.
go back to reference Geelhoed-Duijvestijn PH, Pedersen-Bjergaard U, Weitgasser R, Lahtela J, Jensen MM, Ostenson CG. Effects of patient-reported non-severe hypoglycemia on healthcare resource use, work-time loss, and wellbeing in insulin-treated patients with diabetes in seven European countries. J Med Econ. 2013;16:1453–61.CrossRefPubMed Geelhoed-Duijvestijn PH, Pedersen-Bjergaard U, Weitgasser R, Lahtela J, Jensen MM, Ostenson CG. Effects of patient-reported non-severe hypoglycemia on healthcare resource use, work-time loss, and wellbeing in insulin-treated patients with diabetes in seven European countries. J Med Econ. 2013;16:1453–61.CrossRefPubMed
32.
go back to reference Evans M, Khunti K, Mamdani M, et al. Health-related quality of life associated with daytime and nocturnal hypoglycaemic events: a time trade-off survey in five countries. Health Qual Life Outcomes. 2013;11:90.CrossRefPubMedPubMedCentral Evans M, Khunti K, Mamdani M, et al. Health-related quality of life associated with daytime and nocturnal hypoglycaemic events: a time trade-off survey in five countries. Health Qual Life Outcomes. 2013;11:90.CrossRefPubMedPubMedCentral
33.
go back to reference Bagust A, Beale S. Modelling EuroQol health-related utility values for diabetic complications from CODE-2 data. Health Econ. 2005;14:217–30.CrossRefPubMed Bagust A, Beale S. Modelling EuroQol health-related utility values for diabetic complications from CODE-2 data. Health Econ. 2005;14:217–30.CrossRefPubMed
34.
go back to reference Evans M, Jensen HH, Bogelund M, Gundgaard J, Chubb B, Khunti K. Flexible insulin dosing improves health-related quality-of-life (HRQoL): a time trade-off survey. J Med Econ. 2013;16:1357–65.CrossRefPubMed Evans M, Jensen HH, Bogelund M, Gundgaard J, Chubb B, Khunti K. Flexible insulin dosing improves health-related quality-of-life (HRQoL): a time trade-off survey. J Med Econ. 2013;16:1357–65.CrossRefPubMed
35.
go back to reference Östenson CG, Geelhoed-Duijvestijn P, Lahtela J, Weitgasser R, Markert JM, Pedersen-Bjergaard U. Self-reported non-severe hypoglycaemic events in Europe. Diabet Med. 2014;31:92–101.CrossRefPubMed Östenson CG, Geelhoed-Duijvestijn P, Lahtela J, Weitgasser R, Markert JM, Pedersen-Bjergaard U. Self-reported non-severe hypoglycaemic events in Europe. Diabet Med. 2014;31:92–101.CrossRefPubMed
36.
go back to reference Jensen MM, Pedersen-Bjergaard U. Self-reported frequency and impact of non-severe hypoglycemic events in insulin-treated diabetic patients in Denmark. Diabetes Manag. 2015;5:67–78.CrossRef Jensen MM, Pedersen-Bjergaard U. Self-reported frequency and impact of non-severe hypoglycemic events in insulin-treated diabetic patients in Denmark. Diabetes Manag. 2015;5:67–78.CrossRef
37.
go back to reference Currie CJ, Morgan CL, Poole CD, Sharplin P, Lammert M, McEwan P. Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes. Curr Med Res Opin. 2006;22:1523–34.CrossRefPubMed Currie CJ, Morgan CL, Poole CD, Sharplin P, Lammert M, McEwan P. Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes. Curr Med Res Opin. 2006;22:1523–34.CrossRefPubMed
38.
go back to reference Fidler C, Elmelund Christensen T, Gillard S. Hypoglycemia: an overview of fear of hypoglycemia, quality-of-life, and impact on costs. J Med Econ. 2011;14:646–55.CrossRefPubMed Fidler C, Elmelund Christensen T, Gillard S. Hypoglycemia: an overview of fear of hypoglycemia, quality-of-life, and impact on costs. J Med Econ. 2011;14:646–55.CrossRefPubMed
39.
go back to reference Pedersen-Bjergaard U, Kristensen PL, Nørgaard K, et al. Short-term cost-effectiveness of insulin detemir and insulin aspart in people with type 1 diabetes who are prone to recurrent severe hypoglycemia. Curr Med Res Opin. 2016;20:13–7. Pedersen-Bjergaard U, Kristensen PL, Nørgaard K, et al. Short-term cost-effectiveness of insulin detemir and insulin aspart in people with type 1 diabetes who are prone to recurrent severe hypoglycemia. Curr Med Res Opin. 2016;20:13–7.
40.
go back to reference Jönsson L, Borgström F, Zethraeus N. Cost-effectiveness of alendronate in the treatment of osteoporosis in Denmark—an economic evaluation based on the fracture intervention trial. In: SSE/EFI working paper series in economics and finance, No. 501. Stockholm school of economics; 2002. Jönsson L, Borgström F, Zethraeus N. Cost-effectiveness of alendronate in the treatment of osteoporosis in Denmark—an economic evaluation based on the fracture intervention trial. In: SSE/EFI working paper series in economics and finance, No. 501. Stockholm school of economics; 2002.
41.
go back to reference Ratner R, Gough SC, Mathieu C, et al. Hypoglycaemia risk with insulin degludec compared with insulin glargine in type 2 and type 1 diabetes: a pre-planned meta-analysis of phase 3 trials. Diabetes Obes Metab. 2013;15:175–84.CrossRefPubMed Ratner R, Gough SC, Mathieu C, et al. Hypoglycaemia risk with insulin degludec compared with insulin glargine in type 2 and type 1 diabetes: a pre-planned meta-analysis of phase 3 trials. Diabetes Obes Metab. 2013;15:175–84.CrossRefPubMed
42.
go back to reference Vora J, Christensen T, Rana A, Bain SC. Insulin degludec versus insulin glargine in type 1 and type 2 diabetes mellitus: a meta-analysis of endpoints in phase 3a trials. Diabetes Ther. 2014;5:435–46.CrossRefPubMedPubMedCentral Vora J, Christensen T, Rana A, Bain SC. Insulin degludec versus insulin glargine in type 1 and type 2 diabetes mellitus: a meta-analysis of endpoints in phase 3a trials. Diabetes Ther. 2014;5:435–46.CrossRefPubMedPubMedCentral
43.
go back to reference Hammer M, Lammert M, Mejias SM, Kern W, Frier BM. Costs of managing severe hypoglycaemia in three European countries. J Med Econ. 2009;12:281–90.CrossRefPubMed Hammer M, Lammert M, Mejias SM, Kern W, Frier BM. Costs of managing severe hypoglycaemia in three European countries. J Med Econ. 2009;12:281–90.CrossRefPubMed
44.
go back to reference Lundkvist J, Berne C, Bolinder B, Jonsson L. The economic and quality of life impact of hypoglycemia. Eur J Health Econ. 2005;6:197–202.CrossRefPubMed Lundkvist J, Berne C, Bolinder B, Jonsson L. The economic and quality of life impact of hypoglycemia. Eur J Health Econ. 2005;6:197–202.CrossRefPubMed
Metadata
Title
Cost-Effectiveness of Insulin Degludec/Insulin Aspart Versus Biphasic Insulin Aspart in Patients with Type 2 Diabetes from a Danish Health-Care Perspective
Authors
Marc Evans
Jens Gundgaard
Brian Bekker Hansen
Publication date
01-12-2016
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 4/2016
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-016-0195-6

Other articles of this Issue 4/2016

Diabetes Therapy 4/2016 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.