McCrimmon Rory J, Lamotte Mark, Ramos Mafalda, Alsaleh Abdul Jabbar Omar, Souhami Elisabeth, Lew Elisheva
School of Medicine, University of Dundee, Dundee, UK.
IQVIA Global HEOR, Zaventem, Belgium.
Diabetes Ther. 2021 Dec;12(12):3231-3241. doi: 10.1007/s13300-021-01156-1. Epub 2021 Oct 29.
The fixed-ratio combinations (FRCs) of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and basal insulin, insulin glargine 100 U/mL plus lixisenatide (iGlarLixi), and insulin degludec plus liraglutide (iDegLira), have demonstrated safety and efficacy in patients with type 2 diabetes mellitus (T2DM) inadequately controlled on GLP-1 RAs. However, a comparative cost-effectiveness analysis between these FRCs from a UK Health Service perspective has not been conducted.
The IQVIA Core Diabetes Model was used to estimate lifetime costs and outcomes in patients with T2DM receiving iGlarLixi (based on the LixiLan-G trial) versus iDegLira (based on relative treatment effects from an indirect treatment comparison using data from DUAL III). Utilities, medical costs, and costs of diabetes-related complications were derived from literature. Model outputs included costs and quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios were calculated with a local willingness-to-pay threshold of £20,000 per QALY. Extensive scenario, one-way sensitivity, and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model.
iGlarLixi was less costly (iGlarLixi, £30,011; iDegLira, £40,742), owing to lower acquisition costs, and similar in terms of QALYs gained (iGlarLixi, 8.437; iDegLira, 8.422). Extensive scenario and sensitivity analyses supported the base case findings.
In patients with T2DM and inadequate glycemic control despite GLP-1 RAs, use of iGlarLixi was associated with substantial cost savings and comparable utility outcomes. iGlarLixi can be considered as cost-effective versus iDegLira from the UK Health Service perspective.
胰高血糖素样肽1受体激动剂（GLP-1 RAs）与基础胰岛素的固定比例组合，即100 U/mL甘精胰岛素加利司那肽（iGlarLixi）以及德谷胰岛素加利拉鲁肽（iDegLira），已在接受GLP-1 RAs治疗但血糖控制不佳的2型糖尿病（T2DM）患者中证明了安全性和有效性。然而，尚未从英国国民医疗服务体系的角度对这些固定比例组合进行比较成本效益分析。
使用IQVIA核心糖尿病模型来估计接受iGlarLixi（基于LixiLan-G试验）与iDegLira（基于使用DUAL III数据进行间接治疗比较的相对治疗效果）的T2DM患者的终生成本和结局。效用、医疗成本以及糖尿病相关并发症的成本均来自文献。模型输出包括成本和质量调整生命年（QALY）。以每QALY 20,000英镑的当地支付意愿阈值计算增量成本效益比。进行了广泛的情景分析、单因素敏感性分析和概率敏感性分析，以评估模型的稳健性。
由于采购成本较低，iGlarLixi成本更低（iGlarLixi为30,011英镑；iDegLira为40,742英镑），并且在获得的QALY方面相似（iGlarLixi为8.437；iDegLira为8.422）。广泛的情景分析和敏感性分析支持了基础病例的结果。
在尽管使用了GLP-1 RAs但血糖控制不佳的T2DM患者中，使用iGlarLixi可节省大量成本且效用结局相当。从英国国民医疗服务体系的角度来看，与iDegLira相比，iGlarLixi可被视为具有成本效益。
