Long-Term Cost-Effectiveness of iGlarLixi Versus IDegLira in Patients With Uncontrolled Type 2 Diabetes Treated With Basal Insulin or Oral Antidiabetic Drug in China

OBJECTIVES: Fixed-ratio combinations (FRC) of basal insulin and glucagon-like peptide-1 receptor agonist are novel treatment options for patients with type 2 diabetes (T2D) who fail to achieve glycemic targets on basal insulin (BI) or oral antidiabetic drug (OAD). IDegLira and iGlarLixi are two FRCs approved in China, with iGlarLixi available in two strengths (I/ II). This study assessed long-term cost-effectiveness of iGlarLixi versus IDegLira to support clinical decision-making in China.

METHODS: The IQVIA CORE Diabetes Model was used to simulate clinical and cost outcomes over patient lifetimes from the Chinese healthcare payer’s perspective. Treatment effects of iGlarLixi were extracted from two multi-center open-label randomized controlled trials (LixiLan-O-AP and LixiLan-L-CN) conducted in China for OAD and BI uncontrolled patients, respectively, while those of IDegLira were calculated by indirect treatment comparisons with iGlarLixi. Relative risks of cardiovascular events between the two FRCs from a real-world cohort study were applied. Patients were assumed to switch to basal-bolus insulin when their HbA1c achieved 8%. Utilities and costs of medications and complications were obtained from literature, with costs inflated to 2023 Chinese Yuan. A 5% discount rate was applied.

RESULTS: iGlarLixi (I) and iGlarLixi (II) are primarily used by OAD and BI uncontrolled patients, respectively. OAD uncontrolled patients treated with iGlarLixi (I) gained 0.045 quality-adjusted life years (QALYs) and saved ¥9,355 over patients receiving IDegLira. Similarly, iGlarLixi (II) was associated with 0.020 incremental QALYs and cost savings of ¥7,176 compared to IDegLira for BI uncontrolled patients. Furthermore, iGlarLixi had lower incidences of cardiovascular and diarrhea events. Sensitivity analyses validated robustness of results by changing a wide range of model inputs.

CONCLUSIONS: Lifetime simulations demonstrated that iGlarLixi improved clinical outcomes in comparison to IDegLira for Chinese patients with T2D who fail to achieve glycemic targets. Compared to IDegLira, iGlarLixi was dominant in China with higher QALYs and reduced costs.