Garcia David A, Mau Godfrey, Singh Sumeet, Spence Michaela, Jensen Morten Sall, Goldenberg Ronald
CRG Eversana Canada Inc, Burlington, Canada.
Novo Nordisk Canada Inc, Mississauga, Canada.
J Med Econ. 2025 Dec;28(1):1476-1499. doi: 10.1080/13696998.2025.2551449. Epub 2025 Sep 4.
Patients with type 2 diabetes (T2D) with poor glycemic control despite use of non-insulin agents can experience delay in initiating insulin therapy and poor adherence to insulin therapy, predominantly due to the burden of multiple injections. This study aimed to determine the cost-effectiveness of insulin icodec, first once-weekly basal insulin, compared with long-acting basal insulins for improving glycemic control in adults with T2D in Canada.
The Swedish Institute of Health Economics T2D Cohort Model was used to analyse three T2D groups: insulin naïve (IN), basal insulin experienced (BIE), and basal-bolus insulin experienced (BBIE). Comparators included insulin glargine, insulin detemir, and insulin degludec. Comparative efficacy was informed by the phase 3 ONWARDS trials of insulin icodec and network meta-analyses (NMA). Time horizon was 40 years. Analyses considered disutilities resulting from vascular complications, age, gender, diabetes duration, hypoglycemia, and injection burden. A 1.5% annual discount rate was used for costs and effects. The average cost per unit for each treatment, accounting for the market share of available formats and biosimilars was calculated. Outcomes were expressed as quality-adjusted life-years (QALYs) and cost-effectiveness as incremental cost utility ratios (ICUR [cost/QALY]).
In all analyses, insulin icodec dominated insulin degludec and insulin detemir. Compared to insulin glargine U100 and U300, insulin icodec was associated with ICURs of $17,876, $20,844, and $73,253; and $6,439, $8,623, and $45,433 in the IN, BIE, and BBIE populations, respectively.
Limitations of this economic evaluation include the lack of data for some treatments in certain NMAs, uncertainty regarding the use of the NMA results for a 40-year time horizon, heterogeneous sources of disutilities, and uncertainty regarding the HRQoL benefits of reduced injection frequency.
Insulin icodec is a cost-effective treatment option for adult patients with T2D versus once daily basal insulin-analogues publicly reimbursed in Canada.
尽管使用了非胰岛素药物，但血糖控制不佳的2型糖尿病（T2D）患者在开始胰岛素治疗时可能会延迟，并且对胰岛素治疗的依从性较差，主要原因是多次注射带来的负担。本研究旨在确定每周一次的基础胰岛素icodec与长效基础胰岛素相比，在改善加拿大成年T2D患者血糖控制方面的成本效益。
使用瑞典卫生经济研究所的T2D队列模型分析三个T2D组：初治胰岛素组（IN）、曾使用基础胰岛素组（BIE）和曾使用基础-餐时胰岛素组（BBIE）。对照药物包括甘精胰岛素、地特胰岛素和德谷胰岛素。胰岛素icodec的3期ONWARDS试验和网状Meta分析（NMA）提供了比较疗效数据。时间跨度为40年。分析考虑了血管并发症、年龄、性别、糖尿病病程、低血糖和注射负担导致的效用降低。成本和效果采用每年1.5%的贴现率。计算了每种治疗的单位平均成本，考虑了可用剂型和生物类似药的市场份额。结果以质量调整生命年（QALY）表示，成本效益以增量成本效用比（ICUR[成本/QALY]）表示。
在所有分析中，胰岛素icodec优于德谷胰岛素和地特胰岛素。与甘精胰岛素U100和U300相比，胰岛素icodec在IN、BIE和BBIE人群中的ICUR分别为17,876美元、20,844美元和73,253美元；以及6,439美元、8,623美元和45,433美元。
本经济评估的局限性包括某些NMA中一些治疗缺乏数据、将NMA结果用于40年时间跨度的不确定性、效用降低的异质来源以及降低注射频率对健康相关生活质量益处的不确定性。
与加拿大公共报销的每日一次基础胰岛素类似物相比，胰岛素icodec是成年T2D患者具有成本效益的治疗选择。
