COST-EFFECTIVENESS OF ONCE-WEEKLY ICOSEMA VERSUS INSULIN ICODEC AND INSULIN GLARGINE U100 FOR TREATING TYPE 2 DIABETES IN ITALY: LONG-TERM ANALYSES USING THE PRIME T2D MODEL BASED ON COMBINE 1 AND COMBINE 4
Author(s)
Saikrishna Kandalam, PhD1, Giorgia Guareschi, MSc2, Lucia Sara D'Angiolella, PhD2, Samuel Malkin, MSc3, Barnaby Hunt, MSc3.
1Global Business Services, Novo Nordisk, Bengaluru, India, 2Novo Nordisk, Rome, Italy, 3Ossian Health Economics and Communications, Basel, Switzerland.
1Global Business Services, Novo Nordisk, Bengaluru, India, 2Novo Nordisk, Rome, Italy, 3Ossian Health Economics and Communications, Basel, Switzerland.
OBJECTIVES: Insulin icodec/semaglutide (IcoSema) is a once-weekly, fixed-ratio combination that has demonstrated benefits in adults with type 2 diabetes (T2D) versus once-weekly insulin icodec (post-basal insulin intensification) and once-daily insulin glargine U100 (insulin-naïve, with or without oral antidiabetic medications [OADs]) in the COMBINE 1 and 4 clinical trials, respectively. This analysis assessed the long-term cost-effectiveness of IcoSema in Italy based on COMBINE 1 and 4.
METHODS: Outcomes were projected over a 60-year time horizon using the PRIME T2D Model from the perspective of the Italian National Health Service (SSN). Base case analyses used baseline cohort characteristics and treatment effects (evaluated by the treatment-regimen estimand) from COMBINE 1 and 4, published utilities, Italy-specific costs (expressed in 2024 euros [EUR]), and a hypothetical IcoSema price of EUR 8.23 per 28 units. Patients received assigned treatments for 4 years before intensification with basal-bolus insulin. A published 0.0389 injection utility benefit was applied to IcoSema versus once-daily glargine U100 until intensification, whereas no injection utility benefit was applied versus once-weekly icodec. Cost-effectiveness was assessed against an Italian willingness-to-pay (WTP) threshold of EUR 33,004 per quality-adjusted life year (QALY) gained.
RESULTS: Versus icodec, IcoSema improved quality-adjusted life expectancy by 0.13 QALYs with costs EUR 3,150 higher, yielding an incremental cost-effectiveness ratio (ICER) of EUR 24,114 per QALY gained. Versus glargine U100, IcoSema improved quality-adjusted life expectancy by 0.34 QALYs with costs EUR 11,045 higher, yielding an ICER of EUR 32,964 per QALY gained. IcoSema was therefore considered cost-effective in both comparisons. In probabilistic sensitivity analysis, cost-effectiveness probabilities were 81.1% versus icodec and 72.8% versus glargine U100 at the Italian WTP threshold.
CONCLUSIONS: IcoSema was projected to be cost-effective in Italy across the entire indicated T2D population, including post-basal insulin intensification and insulin initiation following inadequate glycaemic control on OADs.
METHODS: Outcomes were projected over a 60-year time horizon using the PRIME T2D Model from the perspective of the Italian National Health Service (SSN). Base case analyses used baseline cohort characteristics and treatment effects (evaluated by the treatment-regimen estimand) from COMBINE 1 and 4, published utilities, Italy-specific costs (expressed in 2024 euros [EUR]), and a hypothetical IcoSema price of EUR 8.23 per 28 units. Patients received assigned treatments for 4 years before intensification with basal-bolus insulin. A published 0.0389 injection utility benefit was applied to IcoSema versus once-daily glargine U100 until intensification, whereas no injection utility benefit was applied versus once-weekly icodec. Cost-effectiveness was assessed against an Italian willingness-to-pay (WTP) threshold of EUR 33,004 per quality-adjusted life year (QALY) gained.
RESULTS: Versus icodec, IcoSema improved quality-adjusted life expectancy by 0.13 QALYs with costs EUR 3,150 higher, yielding an incremental cost-effectiveness ratio (ICER) of EUR 24,114 per QALY gained. Versus glargine U100, IcoSema improved quality-adjusted life expectancy by 0.34 QALYs with costs EUR 11,045 higher, yielding an ICER of EUR 32,964 per QALY gained. IcoSema was therefore considered cost-effective in both comparisons. In probabilistic sensitivity analysis, cost-effectiveness probabilities were 81.1% versus icodec and 72.8% versus glargine U100 at the Italian WTP threshold.
CONCLUSIONS: IcoSema was projected to be cost-effective in Italy across the entire indicated T2D population, including post-basal insulin intensification and insulin initiation following inadequate glycaemic control on OADs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE177
Topic
Economic Evaluation, Health Technology Assessment, Patient-Centered Research
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity), No Additional Disease & Conditions/Specialized Treatment Areas