VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6
PDB56
COST-EFFECTIVENESS OF LIRAGLUTIDE VERSUS DAPAGLIFLOZIN FOR THE
TREATMENT OF PATIENTS WITH TYPE-2 DIABETES MELLITUS IN THE UK
Schlueter M1, Vega-Hernandez G2, Wojcik R1
1IMS Health, London, UK, 2Novo Nordisk Ltd., Gatwick, UK
OBJECTIVES: Liraglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA)
recommended for the treatment of Type 2 diabetes mellitus (T2DM). To date there
is a lack of economic analysis comparing GLP-1RAs to treatments of the newer
drug class of sodium-glucose co-transporter 2 inhibitors (SGLT-2i). Since liraglu-
tide and dapagliflozin are the most commonly prescribed GLP-1RA and SGLT-2i
in the UK, respectively, this analysis investigated the cost-effectiveness of liraglu-
tide 1.2mg and 1.8mg compared to dapagliflozin 10mg for the treatment of T2DM
in the UK in patients on dual and triple anti-diabetic therapy. METHODS: Cost-
effectiveness analysis was conducted in the IMS CORE Diabetes Model (CDM). The
model estimated expected costs and outcomes over a lifetime horizon using the UK
national payer perspective. Liraglutide efficacy estimates and patient characteristics
were sourced from liraglutide trials in patients on prior metformin therapy and
in patients on prior oral anti-diabetic combination therapy. Comparative efficacy
data applied to these estimates were derived from a network meta-analysis. Utility
inputs were extracted from a systematic literature review. Costs were presented in
GBP 2016. RESULTS: Results showed that liraglutide 1.2mg dominates dapagliflozin
10mg in both double and triple therapy cohorts, providing 0.03 QALY gain/£157 cost
savings and 0.05 QALY gain/£163 cost savings, respectively. Results for liraglutide
1.8mg found increases in efficacy and costs, yielding an ICER of £12,656 in dual
and £13,380 in triple therapy against dapagliflozin. CONCLUSIONS: The present
long-term modelling analysis found that liraglutide 1.2mg is cost-effective when
compared to dapagliflozin 10mg for patients with T2DM on dual or triple therapy
in the UK setting. Additionally, liraglutide 1.8mg is cost-effective vs. dapagliflozin
10mg under the cost-effectiveness thresholds set by NICE (£20,000-£30,000). Both
dosages of liraglutide may therefore present a cost-effective treatment alternative
in patients for whom an SGLT-2i therapy is considered.
PDB57
COST-UTILITY EVALUATION OF INSULIN GLARGINE 300 (GLA-300) VERSUS
INSULIN GLARGINE 100 (GLA-100) IN PATIENTS WITH TYPE 2 DIABETES
MELLITUS (T2DM)
Delgado M1, Rubio M1, Gasche D2, Fournier M3, Monereo S4
1Sanofi, Barcelona, Spain, 2IMS Health, Barcelona, Spain, 3Sanofi, Paris, France, 4Hospital General
Universitario Gregorio Marañón, Madrid, Spain
OBJECTIVES: To evaluate the cost-utility of the new insulin glargine Gla-300
compared with insulin glargine Gla-100 in patients with T2DM in the Spanish
setting. METHODS: A cost-utility model was developed to evaluate clinical and eco-
nomic outcomes. The perspective of the analysis was the Spanish National Health
System (SNS), including direct medical costs and the time horizon considered was
one year. Clinical parameters (hypoglycemia rates and BMI) were obtained from the
pooled analysis of EDITION I, II and III clinical trials (NCT01499082, NCT01499095,
NCT 01676220). Utilities associated with hypoglycemia and dosage flexibility were
derived from literature. Cost parameters considered were drug costs, 40 UI daily
dosage for each insulin, and hypoglycemia costs. Unit costs were extracted from a
Spanish database. Results were expressed in Euros per quality adjusted life years
(QALYs). A one-way sensitivity analysis was conducted to check the robustness
of the results testing the following parameters: price of glargine Gla-100, daily
dosage, utility related to dosage flexibility and utilities related to hypoglycemia
events. RESULTS: Insulin glargine Gla-300 was associated with an incremental
QALY compared to insulin glargine Gla-100 of 0.0058 driven by hypoglycemia rate
reduction in nocturnal non severe hypoglycemia (1,308 vs 2,111 events/patient
year) and dosing flexibility. Total costs associated with insulin glargine Gla-300
were lower than those associated with insulin glargine Gla-100 (909 € vs. 1.065€ )
driven by a lower insulin price and reduced costs associated with hypoglycemic
events. Thus, glargine Gla-300 was a dominant strategy compared to glargine
Gla-100. When considering sensitivity analysis, the robustness of the model was
confirmed. CONCLUSIONS: Based on a reduced incidence of hypoglycemia and
possibility for flexibility around timing of dose administration, use of glargine
Gla-300 is likely to be an efficient and dominant strategy compared to glargine Gla-
100 from the Spanish SNS perspective.
PDB58
FLEXIBLY MODELLING HBA1C PROGRESSION IN TYPE 2 DIABETES TO ESTIMATE
THE IMPACT OF CLINICAL INERTIA ON COSTS AND QUALITY ADJUSTED LIFE
YEARS
McEwan P1, Gordon J1, Bennett H1, Bergenheim K2, Qin L3
1Health Economics and Outcomes Research Ltd, Cardiff, UK, 2AstraZeneca, Mölndal, Sweden,
3AstraZeneca, Gaithersburg, MD, USA
OBJECTIVES: Database studies have demonstrated that delays in treatment intensi-
fication (clinical inertia) in people with type 2 diabetes occur in routine clinical prac-
tice (CP) when compared with recommended guideline escalation (GE) thresholds
(HbA1c 7.5%). The objective of this study was to characterise the clinical and health
economic consequences of this delay in the UK setting. METHODS: To estimate
the consequences of delaying therapy escalation beyond current UK GE thresh-
olds (HbA1c= 7.5%) on costs and quality-adjusted life-years (QALYs), we utilised a
parametric equation capable of replicating HbA1c trajectories observed in patients
requiring therapy escalation from published UK CP data. Mean HbA1c (approxi-
mate duration of diabetes) was 8.0% (1 year) at initiation of monotherapy, 8.5% (3.5
years) at dual therapy and 9.8% (7 years) at insulin initiation. The Cardiff Diabetes
Model was used to compare predicted outcomes associated with the CP trajec-
tory versus HbA1c maintained below the GE threshold. Published utility values and
complication costs (£, 2015) were applied over a lifetime horizon, discounted at 3.5%
annually. RESULTS: Using therapy escalation in line with CP, the model predicted
913 cardiovascular and 165 microvascular events per 1,000 patients; associated
A675
discounted per-patient costs and QALYs were £8,872 and 9.84, respectively. An
HbA1c trajectory maintained below the GE threshold resulted in 789 cardiovascu-
lar and 119 microvascular events per 1,000 patients, and costs and QALYs of £8,260
and 10.19, respectively. Consequently, over a lifetime the per-patient discounted
(undiscounted) impact of clinical inertia in the UK resulted in incremental costs
of £612 (£883) associated with a QALY loss of 0.35 (0.64). CONCLUSIONS: Flexible
parametric HbA1c progression equations enable the health economic consequences
of sub-optimal glycaemic management to be modelled. The additional costs and
decrease in QALYs estimated in this study quantify the significant impact of clinical
inertia at both the payer and patient level compared to achieving guideline levels
of glycaemic control.
PDB59
QUANTIFYING THE HEALTH ECONOMIC VALUE ASSOCIATED WITH UNIT
CHANGES IN HBA1C IN TYPE 1 DIABETES MELLITUS
McEwan P1, Bennett H1, Gordon J1, Bolin K2, Bergenheim K3
1HealthEconomics and Outcomes Research Ltd, Cardiff, UK, 2University of Gothenburg,
Gothenburg, Sweden, 3AstraZeneca, Mölndal, Sweden
OBJECTIVES: Published NICE guidelines recommend that type 1 diabetes mellitus
(T1DM) therapy should aim to reduce HbA1c levels to below 7.5%; however, the
2011-12 UK National Diabetes Audit found that 73% of T1DM patients in England
and Wales failed to achieve and maintain this goal. The objective of this study was
to evaluate the health economic value (per-patient cost-savings and quality adjusted
life year (QALY) gains) associated with unit improvements in HbA1c. METHODS:
This study used the Cardiff T1DM model; microvascular disease progression rates
were derived from DCCT and EDIC, cardiovascular event rates were derived from
the Swedish National Diabetes Registry and published utility values and UK com-
plication costs were applied. The impact of unit improvements in HbA1c (between
6-10%) were evaluated on per-patient cost-savings, QALY gains and subsequent
net monetary benefit (NMB); defined as the amount of additional spend justi-
fied to obtain the QALY gains and cost-savings predicted for each unit change
in HbA1c at a willingness-to-pay threshold of £20,000. All changes were applied
over the first 6 months and maintained for the patient’s lifetime; outcomes were
evaluated over a 60-year horizon and discounted at 3.5% annually. RESULTS: Total
discounted lifetime costs for a 27-year-old T1DM patient with an HbA1c level of
10% was £37,057. Unit (%) improvements of HbA1c from 10% to 6% were associ-
ated with per-patient costs-savings of £7,213, £6,722, £5,549 and £3,307 (totalling
£22,791) as a result of fewer predicted T1DM-related vascular events. Corresponding
incremental QALY gains of 1.26, 1.17, 0.98 and 0.72 QALYs (totalling 4.13 QALYs)
were predicted, equating to NMB of £25,200, £23,400, £19,600 and £14,400 (totalling
£82,600). CONCLUSIONS: This analysis quantifies the cost-savings, QALY improve-
ments and NMB associated improvements in glycaemic control in subjects with
T1DM. The healthcare spend justified to overcome barriers to attaining optimal
glycaemic control in T1DM is considerable.
DIABETES/ENDOCRINE DISORDERS – Patient-Reported Outcomes &
Patient Preference Studies
PDB60
CLINICAL AND ECONOMIC IMPACT OF IMPROVING ADHERENCE TO DIABETES
TREATMENT IN PATIENTS WITH TYPE 2 DIABETES IN SPAIN
Khan-Miron A, Bothma G
Johnson & Johnson Diabetes Care Companies, Zug, Switzerland
OBJECTIVES: Evidence suggests that current levels of adherence to diabetes man-
agement strategies (drug therapy, self-monitoring of blood glucose and life style
recommendations) are alarmingly low. This analysis aims to estimate the economic
value and the clinical impact of sequential increases in the level of adherence
to diabetes treatment among patients with Type 2 diabetes in Spain. METHODS:
Clinical and economic outcomes were calculated based on data derived from pub-
lished sources. These include how adherence variations do impact glycosylated
hemoglobin levels (HbA1c) and how HbA1c variations do impact diabetes related
complications. Inputs also included the estimated current adherence level to dia-
betes treatment, number of patients with Type 2 diabetes in Spain, and costs and
rates for 7 parameters: complications related to diabetes, death related to diabetes,
all-cause mortality for patients with Type 2 diabetes, myocardial infarction, stroke,
amputation and cataract extraction. RESULTS: Each 10% increase in the level of
adherence to diabetes treatment could potentially translate into a 2.8% risk reduc-
tion in complications related to diabetes. If the current 45% non-adherent patients
in Spain would fully adhere to diabetes treatment, the risks of complications and
death due to diabetes would be reduced by 29% and 21% respectively. Considering
there are approximately 1,609,000 non-adherent patients with type 2 diabetes in
Spain, the potential annual total costs savings would exceed 128€ million, which
equal 2.2% of total Spanish diabetes expenditure. CONCLUSIONS: The benefits of
drug therapy in diabetes in terms of glycemic control and complication reduction
have been well established in the literature. However, without regular and compliant
use of medication, therapy benefits would be tremendously reduced. It is, therefore,
critical to undertake effective strategies aimed at improving patient adherence to
diabetes treatment. The results of this analysis might encourage public authori-
ties and HCPs to commit and implement strategies to improve patient adherence.
PDB61
IMPACT OF A COMMUNITY PHARMACY-BASED INFORMATION PROGRAM
ON TYPE 2 DIABETIC PATIENTS’ ADHERENCE TO THEIR ORAL TREATMENT:
IPHODIA, A CLUSTER RANDOMIZED STUDY VS USUAL PRACTICE
Michiels Y1, Bugnon O2, Chicoye A3, Verges B4, Moisan C5, Mechin H6, Allaert F7
1Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of