Cost-utility of exenatide once weekly compared with insulin glargine in patients with type 2 diabetes in the UK

May 14, 2011Journal of medical economics

Cost-effectiveness of weekly exenatide versus insulin glargine for people with type 2 diabetes in the UK

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Abstract

The incremental cost-effectiveness ratio (ICER) for exenatide once weekly compared to insulin glargine is £10,597 per quality-adjusted life-year (QALY) gained.

Exenatide once weekly was more effective and more costly than insulin glargine.
Patients on exenatide experienced an increased time to develop any diabetes-related complication by 0.21 years compared to those on insulin glargine.
In three body mass index (BMI) subgroups (<30, 30-35, and >35 kg/m²), the ICER for exenatide ranged from £9,425 to £12,956 per QALY gained.
The cost per QALY gained for exenatide is within the range typically considered cost-effective by NICE.
Final cost-effectiveness may vary based on the eventual pricing of exenatide and long-term benefits compared to short-term trial results.

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OBJECTIVE: To compare the cost-utility of exenatide once weekly (EQW) and insulin glargine in patients with type 2 diabetes in the United Kingdom (UK).

RESEARCH DESIGN AND METHODS: The IMS CORE Diabetes Model was used to project clinical and economic outcomes for patients with type 2 diabetes treated with EQW or insulin glargine. Treatment effects and patient baseline characteristics (mean age: 58 years, mean glycohaemoglobin: 8.3%) were taken from the DURATION-3 study. Unit costs and health state utility values were derived from published sources. As the price of EQW is not yet known, the prices of two currently available glucagon-like peptide-1 products were used as benchmarks. To reflect diabetes progression, patients started on EQW switched to insulin glargine after 5 years. The analysis was conducted from the perspective of the UK National Health Service over a time horizon of 50 years with costs and outcomes discounted at 3.5%. Sensitivity analyses explored the impact of changes in input data and assumptions and investigated the cost utility of EQW in specific body mass index (BMI) subgroups.

MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER) for EQW compared with insulin glargine.

RESULTS: At a price equivalent to liraglutide 1.2 mg, EQW was more effective and more costly than insulin glargine, with a base case ICER of £10,597 per quality-adjusted life-year (QALY) gained. EQW was associated with an increased time to development of any diabetes-related complication of 0.21 years, compared with insulin glargine. Three BMI subgroups investigated (<30, 30-35 and >35 kg/m(2)) reported ICERs for EQW compared with insulin glargine ranging from £9425 to £12,956 per QALY gained.

CONCLUSIONS: At the prices investigated, the cost per QALY gained for EQW when compared with insulin glargine in type 2 diabetes in the UK setting, was within the range normally considered cost effective by NICE. Cost effectiveness in practice will depend on the final price of EQW and the extent to which benefits observed in short-term randomised trials are replicated in long-term use.

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Cost-utility of exenatide once weekly compared with insulin glargine in patients with type 2 diabetes in the UK

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