Skip to main content
Top
Published in: Diabetes Therapy 6/2017

Open Access 01-12-2017 | Original Research

Cost-Effectiveness of IDegLira Versus Insulin Intensification Regimens for the Treatment of Adults with Type 2 Diabetes in the Czech Republic

Authors: Milan Kvapil, Martin Prázný, Pavel Holik, Karel Rychna, Barnaby Hunt

Published in: Diabetes Therapy | Issue 6/2017

Login to get access

Abstract

Introduction

The aim of this study was to evaluate the long-term cost-effectiveness of the insulin degludec/liraglutide combination (IDegLira) versus basal insulin intensification strategies for patients with type 2 diabetes mellitus (T2DM) not optimally controlled on basal insulin in the Czech Republic.

Methods

Cost-effectiveness was evaluated using the QuintilesIMS Health CORE Diabetes model, an interactive internet-based model that simulates clinical outcomes and costs for cohorts of patients with diabetes. The analysis was conducted from the perspective of the Czech Republic public payer. Sensitivity analyses were conducted to explore the sensitivity of the model to plausible variations in key parameters.

Results

The use of IDegLira was associated with an improvement in the quality-adjusted life expectancy of 0.31 quality-adjusted life-years (QALYs), at an additional cost of Czech Koruna (CZK) 107,829 over a patient’s lifetime compared with basal–bolus therapy, generating an incremental cost-effectiveness ratio (ICER) of CZK 345,052 per QALY gained. In a scenario analysis, IDegLira was associated with an ICER of CZK 693,763 per QALY gained compared to basal insulin + glucagon-like peptide-1 receptor agonist (GLP-1 RA). The ICERs are below the generally accepted willingness-to-pay threshold (CZK 1,100,000/QALY gained at the time of this analysis).

Conclusions

Results from this evaluation suggest that IDegLira is a cost-effective treatment option compared with basal–bolus therapy and basal insulin + GLP-1 RA for patients with T2DM in the Czech Republic whose diabetes is not optimally controlled with basal insulin.

Funding

Novo Nordisk.
Appendix
Available only for authorised users
Footnotes
1
Converted from USD using currency converter http://​www.​xe.​com/​currencyconverte​r, January 2017.
 
2
Státní ústav pro kontrolu léčiv.
 
3
For context 27 CZK was approximately equivalent to 1 EUR at the time of analysis (http://​www.​xe.​com/​currencyconverte​r).
 
Literature
1.
go back to reference Campbell RK, Martin TM. The chronic burden of diabetes. Am J Manag Care. 2009;15:S248–54.PubMed Campbell RK, Martin TM. The chronic burden of diabetes. Am J Manag Care. 2009;15:S248–54.PubMed
3.
go back to reference Bagust A, Beale S. Deteriorating beta-cell function in type 2 diabetes: a long-term model. QJM. 2003;96:281–8.CrossRefPubMed Bagust A, Beale S. Deteriorating beta-cell function in type 2 diabetes: a long-term model. QJM. 2003;96:281–8.CrossRefPubMed
5.
go back to reference Dolezal T, Pisarikova Z, Bartaskova D. The cost of type 2 diabetes mellitus in Czech Republic. Value Health. 2008;11:PDB31 (abstract). Dolezal T, Pisarikova Z, Bartaskova D. The cost of type 2 diabetes mellitus in Czech Republic. Value Health. 2008;11:PDB31 (abstract).
7.
go back to reference Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38:140–9.CrossRefPubMed Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38:140–9.CrossRefPubMed
8.
go back to reference Fonseca V. Defining and characterising the progression of type 2 diabetes. Br J Diabetes Vasc Dis. 2008;8:S3.CrossRef Fonseca V. Defining and characterising the progression of type 2 diabetes. Br J Diabetes Vasc Dis. 2008;8:S3.CrossRef
9.
go back to reference American Diabetes Association. Standards of medical care in diabetes—2017. Diabetes Care. 2017;40. American Diabetes Association. Standards of medical care in diabetes—2017. Diabetes Care. 2017;40.
11.
go back to reference Dale J, Martin S, Gadsby R. Insulin initiation in primary care for patients with type 2 diabetes: 3-year follow-up study. Prim Care Diabetes. 2010;4:85–9.CrossRefPubMed Dale J, Martin S, Gadsby R. Insulin initiation in primary care for patients with type 2 diabetes: 3-year follow-up study. Prim Care Diabetes. 2010;4:85–9.CrossRefPubMed
12.
go back to reference Giugliano D, Maiorino MI, Bellastella G, Chiodini P, Ceriello A, Esposito K. Efficacy of insulin analogs in achieving the hemoglobin A1c target of < 7% in type 2 diabetes: meta-analysis of randomized controlled trials. Diabetes Care. 2011;34:510–7.CrossRefPubMedPubMedCentral Giugliano D, Maiorino MI, Bellastella G, Chiodini P, Ceriello A, Esposito K. Efficacy of insulin analogs in achieving the hemoglobin A1c target of < 7% in type 2 diabetes: meta-analysis of randomized controlled trials. Diabetes Care. 2011;34:510–7.CrossRefPubMedPubMedCentral
13.
go back to reference de Pablos-Velasco P, Parhofer KG, Bradley C, et al. Current level of glycaemic control and its associated factors in patients with type 2 diabetes across Europe: data from the PANORAMA study. Clin Endocrinol (Oxf). 2014;80:47–56.CrossRef de Pablos-Velasco P, Parhofer KG, Bradley C, et al. Current level of glycaemic control and its associated factors in patients with type 2 diabetes across Europe: data from the PANORAMA study. Clin Endocrinol (Oxf). 2014;80:47–56.CrossRef
14.
go back to reference Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Insulin adherence behaviours and barriers in the multinational global attitudes of patients and physicians in insulin therapy study. Diabet Med. 2012;29:682–9.CrossRefPubMedPubMedCentral Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Insulin adherence behaviours and barriers in the multinational global attitudes of patients and physicians in insulin therapy study. Diabet Med. 2012;29:682–9.CrossRefPubMedPubMedCentral
15.
go back to reference United Kingdom Prospective Diabetes Study (UKPDS). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:837–53.CrossRef United Kingdom Prospective Diabetes Study (UKPDS). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:837–53.CrossRef
16.
go back to reference Home PD, Boulton AJM, Jimenez J, Landgraf R, Osterbrink B, Christiansen JS. Issues relating to the early or earlier use of insulin in type 2 diabetes. Pract Diabetes Int. 2003;20:63–71.CrossRef Home PD, Boulton AJM, Jimenez J, Landgraf R, Osterbrink B, Christiansen JS. Issues relating to the early or earlier use of insulin in type 2 diabetes. Pract Diabetes Int. 2003;20:63–71.CrossRef
17.
go back to reference Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364–79.CrossRefPubMedPubMedCentral Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364–79.CrossRefPubMedPubMedCentral
18.
go back to reference Dushay J, Abrahamson MJ. Insulin therapy for type 2 diabetes: making it work. J Fam Pract. 2010;59:E1–8.PubMed Dushay J, Abrahamson MJ. Insulin therapy for type 2 diabetes: making it work. J Fam Pract. 2010;59:E1–8.PubMed
20.
go back to reference Buse JB, Vilsboll T, Thurman J, et al. Contribution of Liraglutide in the fixed-ratio combination of Insulin Degludec and Liraglutide (IDegLira). Diabetes Care. 2014;37:2926–33.CrossRefPubMed Buse JB, Vilsboll T, Thurman J, et al. Contribution of Liraglutide in the fixed-ratio combination of Insulin Degludec and Liraglutide (IDegLira). Diabetes Care. 2014;37:2926–33.CrossRefPubMed
21.
go back to reference Lingvay I, Manghi FP, Garcia-Hernandez P, et al. Effect of insulin glargine up-titration vs insulin degludec/liraglutide on glycated hemoglobin levels in patients with uncontrolled type 2 diabetes: the DUAL V randomized clinical trial. JAMA. 2016;315:898–907.CrossRefPubMed Lingvay I, Manghi FP, Garcia-Hernandez P, et al. Effect of insulin glargine up-titration vs insulin degludec/liraglutide on glycated hemoglobin levels in patients with uncontrolled type 2 diabetes: the DUAL V randomized clinical trial. JAMA. 2016;315:898–907.CrossRefPubMed
22.
go back to reference Freemantle N, Mamdani M, Vilsboll T, Kongso JH, Kvist K, Bain SC. IDegLira versus alternative intensification strategies in patients with type 2 diabetes inadequately controlled on basal insulin therapy. Diabetes Ther. 2015;6:573–91.CrossRefPubMedPubMedCentral Freemantle N, Mamdani M, Vilsboll T, Kongso JH, Kvist K, Bain SC. IDegLira versus alternative intensification strategies in patients with type 2 diabetes inadequately controlled on basal insulin therapy. Diabetes Ther. 2015;6:573–91.CrossRefPubMedPubMedCentral
23.
go back to reference Sassi F. Calculating QALYs, comparing QALY and DALY calculations. Health Policy Plan. 2006;21:402–8.CrossRefPubMed Sassi F. Calculating QALYs, comparing QALY and DALY calculations. Health Policy Plan. 2006;21:402–8.CrossRefPubMed
26.
go back to reference Hunt B, Glah D, van der Vliet M. Modeling the long-term cost-effectiveness of IDegLira in patients with type 2 diabetes who are failing to meet glycemic targets on basal insulin alone in The Netherlands. Diabetes Ther. 2017;8:753–65.CrossRefPubMedPubMedCentral Hunt B, Glah D, van der Vliet M. Modeling the long-term cost-effectiveness of IDegLira in patients with type 2 diabetes who are failing to meet glycemic targets on basal insulin alone in The Netherlands. Diabetes Ther. 2017;8:753–65.CrossRefPubMedPubMedCentral
27.
go back to reference Hunt B, Mocarski M, Valentine WJ, Langer J. IDegLira versus insulin glargine U100: a long-term cost-effectiveness analysis in the US setting. Diabetes Ther. 2017;8:531–44.CrossRefPubMedPubMedCentral Hunt B, Mocarski M, Valentine WJ, Langer J. IDegLira versus insulin glargine U100: a long-term cost-effectiveness analysis in the US setting. Diabetes Ther. 2017;8:531–44.CrossRefPubMedPubMedCentral
28.
go back to reference McEwan P, Foos V, Palmer JL, Lamotte M, Lloyd A, Grant D. Validation of the IMS CORE diabetes model. Value Health. 2014;17:714–24.CrossRefPubMed McEwan P, Foos V, Palmer JL, Lamotte M, Lloyd A, Grant D. Validation of the IMS CORE diabetes model. Value Health. 2014;17:714–24.CrossRefPubMed
29.
go back to reference Palmer AJ, Roze S, Valentine WJ, et al. The CORE Diabetes Model: projecting long-term clinical outcomes, costs and cost-effectiveness of interventions in diabetes mellitus (types 1 and 2) to support clinical and reimbursement decision-making. Curr Med Res Opin. 2004;20[Suppl 1]:S5–26.CrossRefPubMed Palmer AJ, Roze S, Valentine WJ, et al. The CORE Diabetes Model: projecting long-term clinical outcomes, costs and cost-effectiveness of interventions in diabetes mellitus (types 1 and 2) to support clinical and reimbursement decision-making. Curr Med Res Opin. 2004;20[Suppl 1]:S5–26.CrossRefPubMed
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 Clarke P, Gray A, Holman R. Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Med Decis Making. 2002;22:340–9.CrossRefPubMed Clarke P, Gray A, Holman R. Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Med Decis Making. 2002;22:340–9.CrossRefPubMed
35.
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
36.
go back to reference Tengs TO, Wallace A. One thousand health-related quality-of-life estimates. Med Care. 2000;38:583–637.CrossRefPubMed Tengs TO, Wallace A. One thousand health-related quality-of-life estimates. Med Care. 2000;38:583–637.CrossRefPubMed
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 Palmer AJ, Roze S, Valentine WJ, et al. Validation of the CORE Diabetes Model against epidemiological and clinical studies. Curr Med Res Opin. 2004;20(Suppl 1):S27–40.CrossRefPubMed Palmer AJ, Roze S, Valentine WJ, et al. Validation of the CORE Diabetes Model against epidemiological and clinical studies. Curr Med Res Opin. 2004;20(Suppl 1):S27–40.CrossRefPubMed
39.
go back to reference American Diabetes Association Consensus Panel. Guidelines for computer modeling of diabetes and its complications. Diabetes Care. 2004;27:2262–5.CrossRef American Diabetes Association Consensus Panel. Guidelines for computer modeling of diabetes and its complications. Diabetes Care. 2004;27:2262–5.CrossRef
42.
go back to reference Zinman B, Schmidt WE, Moses A, Lund N, Gough S. Achieving a clinically relevant composite outcome of an HbA1c of < 7% without weight gain or hypoglycaemia in type 2 diabetes: a meta-analysis of the liraglutide clinical trial programme. Diabetes Obes Metab. 2012;14:77–82.CrossRefPubMed Zinman B, Schmidt WE, Moses A, Lund N, Gough S. Achieving a clinically relevant composite outcome of an HbA1c of < 7% without weight gain or hypoglycaemia in type 2 diabetes: a meta-analysis of the liraglutide clinical trial programme. Diabetes Obes Metab. 2012;14:77–82.CrossRefPubMed
43.
go back to reference Aroda V, Jaeckel E, Jarlov H, Abrahamsen T, Vilsbøll T. Incidence of gastrointestinal side effects similar between IDegLira and non-GLP-1 RA comparators. Presented at American Diabetes Association (ADA 2015) 75th Scientific Sessions, June 5–9, Boston, MA, p 1009. Aroda V, Jaeckel E, Jarlov H, Abrahamsen T, Vilsbøll T. Incidence of gastrointestinal side effects similar between IDegLira and non-GLP-1 RA comparators. Presented at American Diabetes Association (ADA 2015) 75th Scientific Sessions, June 5–9, Boston, MA, p 1009.
44.
go back to reference Alves C, Batel-Marques F, Macedo AF. A meta-analysis of serious adverse events reported with exenatide and liraglutide: acute pancreatitis and cancer. Diabetes Res Clin Pract. 2012;98:271–84.CrossRefPubMed Alves C, Batel-Marques F, Macedo AF. A meta-analysis of serious adverse events reported with exenatide and liraglutide: acute pancreatitis and cancer. Diabetes Res Clin Pract. 2012;98:271–84.CrossRefPubMed
Metadata
Title
Cost-Effectiveness of IDegLira Versus Insulin Intensification Regimens for the Treatment of Adults with Type 2 Diabetes in the Czech Republic
Authors
Milan Kvapil
Martin Prázný
Pavel Holik
Karel Rychna
Barnaby Hunt
Publication date
01-12-2017
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 6/2017
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-017-0323-y

Other articles of this Issue 6/2017

Diabetes Therapy 6/2017 Go to the issue