A. Beaudet

Review of Utility Values for Economic Modeling in Type 2 Diabetes

OBJECTIVES Economic analysis in type 2 diabetes mellitus (T2DM) requires an assessment of the effect of a wide range of complications. The objective of this article was to identify a set of utility values consistent with the National Institute for Health and Care Excellence (NICE) reference case and to critically discuss and illustrate challenges in creating such a utility set. METHODS A systematic literature review was conducted to identify studies reporting utility values for relevant complications. The methodology of each study was assessed for consistency with the NICE reference case. A suggested set of utility values applicable to modeling was derived, giving preference to studies reporting multiple complications and correcting for comorbidity. RESULTS The review considered 21 relevant diabetes complications. A total of 16,574 articles were identified; after screening, 61 articles were assessed for methodological quality. Nineteen articles met NICE criteria, reporting utility values for 20 of 21 relevant complications. For renal transplant, because no articles meeting NICE criteria were identified, two articles using other methodologies were included. Index value estimates for T2DM without complication ranged from 0.711 to 0.940. Utility decrement associated with complications ranged from 0.014 (minor hypoglycemia) to 0.28 (amputation). Limitations associated with the selection of a utility value for use in economic modeling included variability in patient recruitment, heterogeneity in statistical analysis, large variability around some point estimates, and lack of recent data. CONCLUSIONS A reference set of utility values for T2DM and its complications in line with NICE requirements was identified. This research illustrates the challenges associated with systematically selecting utility data for economic evaluations.

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

Abstract 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/m2) 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.

Cost-Effectiveness of Biphasic Insulin Aspart versus Insulin Glargine in Patients with Type 2 Diabetes in China

BackgroundThe OnceMix and INITIATE studies have indicated that biphasic insulin aspart 30 (BIAsp 30) is more effective than insulin glargine (IGlarg), in terms of glycohemoglobin reductions, in patients with type 2 diabetes initiating insulin therapy. The cost-effectiveness of BIAsp 30 versus IGlarg in the Chinese setting is estimated here.MethodsThe validated and peer-reviewed CORE Diabetes Model was used. The nephropathy, retinopathy, and stroke submodels were modified to incorporate available Chinese clinical data. Diabetes complication costs were derived from hospital surveys in Beijing and Chengdu. Simulated cohorts and insulin treatment effects were based on the OnceMix study for once-daily BIAsp 30 versus IGlarg and on the INITIATE study for twice-daily BIAsp 30 versus IGlarg. Life expectancy and direct medical costs were calculated. Projections were made over 30-year time horizons, with costs and life years discounted at 3% annually. Extensive sensitivity analyses were performed, including adjustments to cardiovascular risk for Chinese ethnicity.ResultsOnce-daily BIAsp 30 increased life expectancy by 0.04 years (12.37 vs. 12.33 years) and reduced direct medical costs by Chinese Yuan (CNY) 59,710 per patient (CNY 229,911 vs. CNY 289,621 per patient) compared with IGlarg in the OnceMix-based analysis. Twice-daily BIAsp 30 increased life expectancy by 0.08 years (12.99 vs. 12.91 years) and reduced direct medical costs by CNY 107,349 per patient (CNY 303,142 vs. CNY 410,491 per patient) compared with IGlarg in the INITIATE-based analysis. Improvements in life expectancy were driven by reduced incidences of most diabetes-related complications. Cost savings were attributable to lower lifetime insulin costs for BIAsp 30 compared with IGlarg in China. Lowered cardiovascular risk for Chinese ethnicity reduced the projected clinical improvements for BIAsp 30 but increased treatment-related lifetime cost savings.ConclusionsBIAsp 30, either once- or twice-daily, improved projected life expectancy and reduced projected costs compared with IGlarg in the Chinese setting.