Cost-Effectiveness of GLP-1 Receptor Agonists Versus Long-Acting Insulins in Type 2 Diabetes From the Healthcare Sector Perspective: A Model-Based Analysis Using Real-World Data
Author(s)
Yao WY1, Yang CT2, Ou HT3, Kuo S4
1Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, 2Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, TNN, Taiwan, 3Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan, 4Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Tainan City, Taiwan
Presentation Documents
OBJECTIVES:
Most previous cost-effectiveness analyses (CEAs) of glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus long-acting insulins (LAIs) utilized the effectiveness parameters which were derived from clinical trials and not country/population-specific, and it may thus have limited study generalizability to real-world settings. We conducted a model-based CEA of GLP-1RAs versus LAIs from the Taiwan healthcare sector perspective using data from a real-world Taiwanese cohort of type 2 diabetes (T2D) to inform real-world decision-making.METHODS:
A Markov model was applied to simulate the T2D progression and the occurrence of cardiovascular diseases (CVDs; myocardial infarction, stroke, heart failure) and death. Effectiveness parameters were estimated from a T2D population who initiated a GLP-1RA or LAI using the Taiwan’s National Health Insurance Research Database. A 10-year time horizon and a 3% annual discount rate on cost and effectiveness outcomes (quality-adjusted life years [QALYs]) were employed in the base-case analysis. Costs were expressed in 2021 USD. Sensitivity and scenario analyses were performed to examine uncertainty arisen from input parameters and model assumptions. Subgroup analyses were conducted to explore the heterogeneity of results across patient subgroups (e.g., those with established CVDs or chronic kidney disease).RESULTS:
The use of GLP-1RAs versus LAIs cost USD 6,079 per QALY gained. Probabilistic sensitivity analysis showed that GLP-1RAs were considered as cost-effective in 100% of model iterations under the willingness-to-pay threshold of USD 33,011 per QALY gained (i.e., one-time per capita gross domestic product in Taiwan in 2021). Subgroup analysis results also demonstrated cost-effective results as those in the base-case analysis, except that using GLP-1RAs was cost-saving among patients with established CVDs.CONCLUSIONS:
Using GLP-1RAs is cost-effective compared with LAIs among T2D patients from the Taiwan healthcare sector perspective. Such economic benefit is even prominent among those with prior CVDs, which provides clinical and policy implications to support treatment priority and reimbursement.Conference/Value in Health Info
Value in Health, Volume 25, Issue 12S (December 2022)
Code
EE40
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), STA: Drugs