OBJECTIVES : To evaluate the short-term cost-effectiveness of insulin degludec (degludec) versus insulin glargine 300 units/mL (glargine U300) in insulin-treated patients with type 2 diabetes (T2D) from the perspective of a Dutch public healthcare payer.

METHODS : A published decision-analytic model in Microsoft Excel estimated costs (2019 Euros [EUR]) and quality-adjusted life-years [QALYs]) with degludec versus glargine U300. This model captured the effects of insulin dosing and hypoglycaemia (non-severe daytime, non-severe nocturnal and severe) over a 1-year time horizon. Clinical outcomes were informed by CONCLUDE (NCT03078478), a head-to-head RCT comparing the hypoglycaemia risk with degludec versus that with glargine U300 in insulin-treated patients with T2D, utilising data from the 36-week maintenance treatment period. For simplicity, a small but significant improvement in glycaemic control (favouring degludec) was not included in this short-term model.

RESULTS : CONCLUDE demonstrated significantly lower rates of non-severe nocturnal (rate ratio [RR]: 0.63 [95% CI: 0.48;0.84]) and severe (RR: 0.20 [95% CI: 0.07;0.57]) hypoglycaemia with degludec versus glargine U300, with no significant treatment difference for non-severe daytime hypoglycaemia. Treatment with degludec was associated with mean annual cost savings per patient (EUR 24.71) relative to glargine U300, driven predominately by a lower basal insulin dose (end-of-trial dose[units/kg] ratio: 0.87 [95% CI: 0.82;0.92]) and somewhat by lower incidence of severe hypoglycaemia with degludec, which more than offset the slightly higher basal insulin unit cost. Reduced risks of non-severe nocturnal and severe hypoglycaemia resulted in improved effectiveness with degludec (0.0045 QALYs) relative to glargine U300. Overall, degludec was a dominant treatment option (improved effectiveness at lower cost) versus glargine U300. The overall result was robust in sensitivity analyses.

CONCLUSIONS : This short-term cost-effectiveness analysis informed by RCT evidence demonstrates that degludec is a dominant treatment option versus glargine U300 in insulin-treated patients with T2D, from the perspective of a Dutch public healthcare payer.