Hunt B, Mocarski M, Valentine W J, Langer J
a Ossian Health Economics and Communications , Basel , Switzerland.
b Novo Nordisk Inc. , Plainsboro , NJ , USA.
J Med Econ. 2017 Jul;20(7):663-670. doi: 10.1080/13696998.2017.1301943. Epub 2017 Mar 15.
IDegLira, a fixed ratio combination of insulin degludec and glucagon-like peptide-1 receptor agonist liraglutide, utilizes the complementary mechanisms of action of these two agents to improve glycemic control with low risk of hypoglycemia and avoidance of weight gain. The aim of the present analysis was to assess the long-term cost-effectiveness of IDegLira vs liraglutide added to basal insulin, for patients with type 2 diabetes not achieving glycemic control on basal insulin in the US setting.
Projections of lifetime costs and clinical outcomes were made using the IMS CORE Diabetes Model. Treatment effect data for patients receiving IDegLira and liraglutide added to basal insulin were modeled based on the outcomes of a published indirect comparison, as no head-to-head clinical trial data is currently available. Costs were accounted in 2015 US dollars ($) from a healthcare payer perspective.
IDegLira was associated with small improvements in quality-adjusted life expectancy compared with liraglutide added to basal insulin (8.94 vs 8.91 discounted quality-adjusted life years [QALYs]). The key driver of improved clinical outcomes was the greater reduction in glycated hemoglobin associated with IDegLira. IDegLira was associated with mean costs savings of $17,687 over patient lifetimes vs liraglutide added to basal insulin, resulting from lower treatment costs and cost savings as a result of complications avoided.
The present long-term modeling analysis found that IDegLira was dominant vs liraglutide added to basal insulin for patients with type 2 diabetes failing to achieve glycemic control on basal insulin in the US, improving clinical outcomes and reducing direct costs.
德谷胰岛素利拉鲁肽（IDegLira）是德谷胰岛素与胰高血糖素样肽-1受体激动剂利拉鲁肽的固定比例复方制剂，利用这两种药物互补的作用机制来改善血糖控制，低血糖风险低且可避免体重增加。本分析的目的是评估在美国背景下，对于基础胰岛素治疗血糖控制不佳的2型糖尿病患者，IDegLira对比加用利拉鲁肽的基础胰岛素治疗的长期成本效益。
使用IMS CORE糖尿病模型对终身成本和临床结局进行预测。由于目前尚无直接对比的临床试验数据，因此基于已发表的间接对比结果对接受IDegLira和加用利拉鲁肽的基础胰岛素治疗的患者的治疗效果数据进行建模。从医疗保健支付者的角度，成本按2015年美元计算。
与加用利拉鲁肽的基础胰岛素治疗相比，IDegLira与质量调整生命预期的小幅改善相关（贴现质量调整生命年分别为8.94和8.91）。临床结局改善的关键驱动因素是IDegLira使糖化血红蛋白降低幅度更大。与加用利拉鲁肽的基础胰岛素治疗相比，IDegLira使患者终身平均成本节省17,687美元，这是由于治疗成本较低以及避免并发症带来的成本节省。
目前的长期建模分析发现，对于在美国基础胰岛素治疗血糖控制不佳的2型糖尿病患者，IDegLira对比加用利拉鲁肽的基础胰岛素治疗具有优势，可改善临床结局并降低直接成本。
