OBJECTIVES: We evaluated the economic aspects associated with the use of 2^nd generation basal insulin analogs in type 2 diabetes (T2D) patients, Glargine 300 Units/ml (Gla-300) and Degludec 100 Units/ml (iDeg), in Italy, through an analysis based on BRIGHT study, the first randomized, controlled, head-to-head study on these insulins.

METHODS: The analysis was conducted in adult insulin-naive patients with T2D inadequately controlled with oral antihyperglycemic therapy with/without Glucagon-like peptide-1 receptor agonist at stable dose for at least 3 months, adopting the Italian National Health Service (INHS) perspective. In the BRIGHT study, patients were randomized to Gla-300 or iDeg for 24 weeks. The model considered pharmacological costs only. Accordingly, a cost minimization analysis (CMA) and a budget impact analysis (BIA) were conducted. The CMA estimated patient treatment costs at 24 weeks and 1 year, while the BIA assessed the economic impact of treating the overall Italian patient population of T2D insulin-naïve and newly treated with the two insulins in 2018 (N=55,318). Four different scenarios were compared: 1) all patients treated with iDeg; 2) current treatment rate in Italy (61% Gla-300, 39% iDeg); 3) 80% Gla-300, 20% iDeg; and 4) all patients treated with Gla-300.

RESULTS: The average treatment costs per patient at 24 weeks and 1 year were higher with IDeg when compared to Gla-300 (at 24 weeks: €161 vs €129; at 1 year: €409 vs €324). Results of the BIA showed that a greater use of Gla-300 reduced INHS costs: comparing Scenario 4 vs Scenario 1, total savings were €1.8 million at 24 week and €4.7 million at 1-year. An additional BIA, extended to the second year of treatment, strengthened the results of the 24-week and 1-year analyses.

CONCLUSIONS: This analysis provides evidence that, the use of iGla-300, rather than iDeg, would result in a robust saving for the INHS.