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03-27-2017 | Insulin degludec/Liraglutide | Article

IDegLira Versus Insulin Glargine U100: A Long-term Cost-effectiveness Analysis in the US Setting

Journal: Diabetes Therapy

Authors: Barnaby Hunt, Michelle Mocarski, William J. Valentine, Jakob Langer

Publisher: Springer Healthcare




Treatment with IDegLira has the potential to improve glycemic control in patients with type 2 diabetes mellitus (T2DM) without the weight gain and with a lower risk of hypoglycemia than with other therapies. The aim of the present analysis was to evaluate the long-term cost-effectiveness of IDegLira versus insulin glargine U100 with re-education and up-titration of the dose for treatment of patients with T2DM failing to achieve glycemic control on basal insulin in the US setting.


Data were obtained from the DUAL V randomized controlled trial in which adults with T2DM failing to achieve glycemic targets with insulin glargine U100 were randomly allocated to receive either IDegLira or insulin glargine U100. Long-term projections of clinical outcomes and direct costs were made using the IMS CORE Diabetes Model. Costs were accounted from a healthcare payer perspective. Future costs and clinical benefits were discounted at 3% annually.


IDegLira was associated with improved discounted life expectancy (13.99 [standard deviation 0.19] versus 13.82 [standard deviation 0.20] years) and quality-adjusted life expectancy (9.14 [standard deviation 0.12] versus 8.87 [standard deviation 0.13] quality-adjusted life years [QALYs]) compared to insulin glargine U100. IDegLira was associated with increased direct costs of $16,970, yielding an incremental cost-effectiveness ratio (ICER) of $63,678 per QALY gained versus insulin glargine U100. Sensitivity analyses identified that the key driver of cost-effectiveness was the greater reduction in glycated hemoglobin with IDegLira compared with insulin glargine U100.


Based on head-to-head clinical trial data, the present analysis suggests that IDegLira is likely to improve long-term clinical outcomes for patients with T2DM not achieving glycemic control on basal insulin compared to re-education and up-titration of the dose of insulin glargine U100, with these improvements coming at an increased cost from a healthcare payer perspective. An ICER within the range described as high care value was calculated, suggesting IDegLira is a cost-effective treatment option in the US.
Funding: Novo Nordisk A/S and Novo Nordisk Inc.
Zhang P, Zhang X, Brown J, et al. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(3):293–301. CrossRefPubMed
American Diabetes Association. Economic costs of diabetes in the US in 2012. Diabetes Care. 2013;36:1033–46. CrossRefPubMedCentral
UK Prospective Diabetes Study Group. UK prospective diabetes study 16: overview of 6 years’ therapy of type II diabetes: a progressive disease. Diabetes. 1995;44(11):1249–58. CrossRef
Nathan DM. Clinical practice. Initial management of glycemia in type 2 diabetes mellitus. N Engl J Med. 2002;347(17):1342–9. CrossRefPubMed
Russell-Jones D, Khan R. Insulin-associated weight gain in diabetes-causes, effects and coping strategies. Diabetes Obes Metab. 2007;9(6):799–812. CrossRefPubMed
Eng C, Kramer CK, Zinman B, Retnakaran R. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet. 2014;384(9961):2228–34. CrossRefPubMed
American Diabetes Association. 7. Approaches to glycemic treatment. Diabetes Care. 2016;39:S52–9. CrossRef
Davies MJ, Glah D, Chubb B, Konidaris G, McEwan P. Cost effectiveness of IDegLira vs. alternative basal insulin intensification therapies in patients with type 2 diabetes mellitus uncontrolled on basal insulin in a UK setting. Pharmacoeconomics. 2016;34(9):953–66. CrossRefPubMed
Ericsson Å, Lundqvist A. Cost effectiveness of insulin degludec plus liraglutide (IDegLira) in a fixed combination for uncontrolled type 2 diabetes mellitus in Sweden. Appl Health Econ Health Policy. 2017;15(2):237–48.
Prades M, Lizan L, Hunt B, Ramirez de Arellano A. Long-term cost utility analysis of IDegLira versus basal-bolus insulin intensification therapies in patients with type 2 diabetes inadequately controlled on basal insulin in Spain. Val Health. 2016;19(3):A99.
Hunt B, Mocarski M, Valentine WJ, Langer J. Evaluation of the long-term cost-effectiveness of ideglira versus liraglutide added to basal insulin for patients with type 2 diabetes failing to achieve glycemic control on basal insulin in the USA. 2017. doi: 10.​1080/​13696998.​2017.​1301943.
Lingvay I, Manghi FP, García-Hernández 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(9):898–907. CrossRefPubMed
Wright A, Burden AC, Paisey RB, Cull CA, Holman RR. Sulfonylurea inadequacy: efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the UK Prospective Diabetes Study (UKPDS 57). Diabetes Care. 2002;25(2):330–6. CrossRefPubMed
Holman RR, Farmer AJ, Davies MJ, et al. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med. 2009;361(18):1736–47. CrossRefPubMed
Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129–39. CrossRefPubMed
Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59. CrossRefPubMed
Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72. CrossRefPubMed
Medi-Span Price Rx. http://​www.​wolterskluwercdi​.​com/​price-rx/​. Accessed 16 Oct 2017.
Yeaw J, Lee WC, Aagren M, Christensen T. Cost of self-monitoring of blood glucose in the United States among patients on an insulin regimen for diabetes. J Manag Care Pharm. 2012;18(1):21–32. PubMed
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(8):1523–34. CrossRefPubMed
Rosenstock J, Fonseca V, McGill JB, et al. Similar progression of diabetic retinopathy with insulin glargine and neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes: a long-term, randomised, open-label study. Diabetologia. 2009;52(9):1778–88. CrossRefPubMedPubMedCentral
McEwan P, Foos V, Palmer JL, Lamotte M, Lloyd A, Grant D. Validation of the IMS CORE diabetes model. Value Health. 2014;17(6):714–24. CrossRefPubMed
American Diabetes Association Consensus Panel. Guidelines for computer modeling of diabetes and its complications. Diabetes Care. 2004;27(9):2262–5. CrossRef
Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.
Pizzi LT. The Institute for Clinical and Economic Review and its growing influence on the US healthcare. Am Health Drug Benefits. 2016;9(1):9–10. PubMedPubMedCentral
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):5–26. CrossRef
Palmer AJ, Roze S, Valentine W, et al. Validation of the CORE Diabetes Model against epidemiological and clinical studies. Curr Med Res Opin. 2004;20(Suppl 1):27–40. CrossRef
Boye KS, Matza LS, Walter KN, Van Brunt K, Palsgrove AC, Tynan A. Utilities and disutilities for attributes of injectable treatments for type 2 diabetes. Eur J Health Econ. 2011;12(3):219–30. CrossRefPubMed
Cefalu WT, Buse JB, Del Prato S, et al. Beyond metformin: safety considerations in the decision-making process for selecting a second medication for type 2 diabetes management: reflections from a diabetes care editors’ expert forum. Diabetes Care. 2014;37(9):2647–59. CrossRefPubMedPubMedCentral
Buse JB, Vilsbøll T, Thurman J, et al. NN9068-3912 (DUAL-II) Trial Investigators. Contribution of liraglutide in the fixed-ratio combination of insulin degludec and liraglutide (IDegLira). Diabetes Care. 2014;37(11):2926–33. 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(4):340–9. CrossRefPubMed
Tengs TO, Wallace A. One thousand health-related quality-of-life estimates. Med Care. 2000;38(6):583–637. CrossRefPubMed
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(1):90. CrossRefPubMedPubMedCentral
Bagust A, Beale S. Modelling EuroQol health-related utility values for diabetic complications from CODE-2 data. Health Econ. 2005;14(3):217–30. CrossRefPubMed
Yeaw J, Halinan S, Hines D, et al. Direct medical costs for complications among children and adults with diabetes in the US commercial payer setting. Appl Health Econ Health Policy. 2014;12(2):219–30. CrossRefPubMed
Foos V, Varol N, Curtis BH, et al. Economic impact of severe and non-severe hypoglycemia in patients with type 1 and type 2 diabetes in the United States. J Med Econ. 2015;18(6):420–32. CrossRefPubMed
Ramulu PY, Do DV, Corcoran KJ, Robin AL. Use of retinal procedures in medicare beneficiaries from 1997 to 2007. Arch Ophthalmol. 2010;128(10):1335–40. CrossRefPubMed
Department of Health and Human Services. Questionable billing by suppliers of lower limb prostheses. https://​oig.​hhs.​gov/​oei/​reports/​oei-02-10-00170.​pdf. Accessed 16 Oct 2017.
Carroll K. Older adults can thrive as prosthesis users. Senior Step. http://​www.​amputee-coalition.​org/​senior_​step/​older_​prosthesis_​users.​html. Accessed 16 Oct 2017.

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