OBJECTIVES: The Step-by-step clinical trial (NCT02906917) in basal insulin ± oral antidiabetic drugs treated people with type 2 diabetes (T2D) confirmed a similar glycemic effect for insulin degludec/insulin aspart (IDegAsp) versus basal+bolus insulin treatment (BB) of IGlar U100 + IAsp that was consistent over 38-weeks period with a significantly lower risk of nocturnal hypoglycemia. The aim of the present analysis was to assess the short-term cost-effectiveness of IDegAsp vs BB in Indian setting.

METHODS: A short-term cost-effectiveness model (1-year time horizon) developed in Microsoft Excel was used to estimate the incremental cost effectiveness ratio (ICER) for IDegAsp versus BB from a patient payer perspective. Baseline cohort characteristics and treatment effects were based on 38-week data from the trial. Drug acquisition costs based on maximum retail price in India as of June 2022 were taken into consideration, and the cost for hypoglycemia and disutility data for events and monitoring were derived from published literature.

RESULTS: Over a 1-year time horizon, IDegAsp therapy resulted in an improvement of 0.0086 (0.7834 vs 0.7748) quality-adjusted life years (QALYs) as compared to BB. Lower insulin dose requirement with IDegAsp, lesser need for monitoring and number of injections coupled with lower risk of nocturnal hypoglycemia contributed to cost saving of INR 4,219.53 (1,60,498 vs 1,64,718, dominant for ICER) vs BB.

CONCLUSIONS: Based on short-term cost effectiveness analysis in Indian setting, IDegAsp is dominant (i.e., less costly, with greater clinical benefit) vs. BB for people with T2D undergoing stepwise intensification.