Insulin Degludec May Be More Cost Effective Than Insulin Glargine or Its Biosimilar

Insulin degludec (Tresiba) is a cost-effective alternative to insulin glargine U100 (Lantus) for patients with diabetes, and it is also likely to be more cost-effective than 2 newly marketed basal insulin analogues, according to a recent study funded by Novo Nordisk and published in Diabetes Therapy.

Marc Evans, MD, and colleagues used a short-term model to evaluate the costs and effects of treatment with insulin degludec versus insulin glargine over a 12-month period in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) from the perspective of the United Kingdom’sNational Health Service—that is, in light of the recent reduction in the price of insulin degludec and the addition of 2 new basal insulin analogues to the marketplace: insulin glargine U300 (Toujeo) and a biosimilar to insulin glargine U100 (Abasaglar).

The cost-effectiveness model was designed to reflect a more generalizable patient population, including patients with T2D on a basal-bolus regimen. It calculates costs associated with treatment and hypoglycemic events, and calculates quality adjusted life years by applying a disutility per hypoglycemic event.

Insulin degludec is a basal insulin with an ultra-long duration of action (more than 42 hours) and a flat and stable action profile; it has 4 times less day-to-day variation in glucose-lowering effect than insulin glargine U100. In clinical trials, insulin degludec showed equivalent reductions in glycated hemoglobin, a lower risk of hypoglycemia compared with insulin glargine U100, and a significantly lower daily dose when compared with insulin glargine U100 in T1D and T2D basal oral therapy. The researchers note that the benefits of insulin degludec have been reported in real-world clinical practice, with significant (more than 90%) reductions in hypoglycemia, and with improved glycemic control. However, in the United Kingdom, insulin glargine U100 is currently the most widely prescribed basal insulin.

The cost-utility study compared insulin degludec with insulin glargine U100 in 3 separate patient groups:

• Patients with T1D who use a basal-bolus regimen

• Patients with T2D who use a basal oral therapy regimen
• Patients with T2D who use a basal-bolus regimen

The analysis found the following:

• Insulin degludec is more effective and less costly than insulin glargine U100 in patients with T1D and patients with T2D on a basal-only therapy regimen
• Insulin degludec is more cost effective than insulin glargine U100 in patients with T2D on a basal-bolus regimen
• In patients with T1D, lower treatment costs are primarily driven by lower insulin costs that result from a lower daily dose of insulin degludec
• In patients with T2D taking basal-only therapy, lower overall costs with insulin degludec are driven by lower costs arising from severe hypoglycemic events
• This reduction is due to the significant decrease in the number of events with insulin degludec versus insulin glargine U100

Improvements in clinical outcomes in all 3 patient groups are a result of the reduced incidence of hypoglycemic events, the authors conclude. In patients with T1D and T2D on basal-only therapy, insulin degludec is likely to be highly cost effective versus the insulin glargine biosimilar Abasaglar, and both more effective and less costly than insulin glargine U300. In patients with T2D on a basal-bolus regimen, insulin degludec is likely to be more cost effective than either of the comparators. The study’s authors believe that insulin degludec may particularly benefit those experiencing hypoglycemia while taking other basal insulin analogues, or may prove useful to patients who would benefit from additional flexibility in their therapy.