McCrimmon Rory J, Palmer Karen, Alsaleh Abdul Jabbar Omar, Lew Elisheva, Puttanna Amar
Systems Medicine, School of Medicine, University of Dundee, Dundee, UK.
Sanofi, Reading, UK.
Diabetes Ther. 2022 Jun;13(6):1203-1214. doi: 10.1007/s13300-022-01267-3. Epub 2022 May 11.
iGlarLixi is indicated as an adjunct to diet and exercise in addition to metformin (with or without sodium-glucose cotransporter-2 inhibitors) to improve glycemic control in adults with insufficiently controlled type 2 diabetes (T2D). A cost-effectiveness analysis was conducted to compare iGlarLixi with premix biphasic insulin aspart 30 (BIAsp 30) in people with T2D suboptimally controlled with basal insulin (BI).
The IQVIA CORE Diabetes Model was used to estimate lifetime costs and outcomes for people with T2D from a UK health care perspective at a willingness-to-pay threshold of £20,000. Initial clinical data were based on the phase 3 randomized, open-label, active-controlled SoliMix clinical trial which compared the efficacy and safety of once-daily iGlarLixi with that of twice-daily BIAsp 30. Costs associated with management and complications and utilities values were derived from published sources. Lifetime costs (in £GBP) and quality-adjusted life-years (QALYs) were predicted; extensive scenario and sensitivity analyses were conducted.
Estimated QALYs gained were slightly higher with iGlarLixi (8.9 vs. 8.8) compared with premix BIAsp 30, at a higher cost (£23,204 vs. £21,961). The base case incremental cost-effectiveness ratio (ICER) per QALY was £13,598. Treatment acquisition was the main driver of cost differences (iGlarLixi, £11,750; premix BIAsp 30, £10,395). Costs associated with management and complications were generally similar between comparators.
iGlarLixi provides improved QALY outcomes at an acceptable cost compared with premix BIAsp 30, with an ICER below the threshold generally considered acceptable by UK authorities. In people with T2D, iGlarLixi is a simple, cost-effective option for advancing therapy of BI, with fewer daily injections than premix BIAsp 30.
iGlarLixi被指定作为饮食和运动的辅助手段，联合二甲双胍（加或不加钠-葡萄糖协同转运蛋白2抑制剂），用于改善2型糖尿病（T2D）控制不佳的成人患者的血糖控制。开展了一项成本效益分析，以比较iGlarLixi与预混双相门冬胰岛素30（BIAsp 30）在基础胰岛素（BI）治疗效果欠佳的T2D患者中的情况。
采用IQVIA核心糖尿病模型，从英国医疗保健角度，以20,000英镑的支付意愿阈值估算T2D患者的终生成本和结局。初始临床数据基于3期随机、开放标签、活性对照的SoliMix临床试验，该试验比较了每日一次iGlarLixi与每日两次BIAsp 30的疗效和安全性。与管理及并发症相关的成本以及效用值均来源于已发表的资料。预测了终生成本（以英镑计）和质量调整生命年（QALY）；进行了广泛的情景分析和敏感性分析。
与预混BIAsp 30相比，iGlarLixi获得的估计QALY略高（8.9对8.8），但成本更高（23,204英镑对21,961英镑）。每QALY的基础病例增量成本效益比（ICER）为13,598英镑。治疗费用是成本差异的主要驱动因素（iGlarLixi为11,750英镑；预混BIAsp 30为10,395英镑）。比较组之间与管理及并发症相关的成本总体相似。
与预混BIAsp 30相比，iGlarLixi以可接受的成本提供了更好的QALY结局，ICER低于英国当局通常认为可接受的阈值。在T2D患者中，iGlarLixi是推进BI治疗的一种简单、具有成本效益的选择，每日注射次数比预混BIAsp 30少。
