OBJECTIVES: Type 2 diabetes mellitus (T2D) is a chronic disease with high healthcare costs. This study aims to compare costs between Glargine-300U/ml and Degludec-100U/ml associated with macrovascular events (ME) in an older population (>70 years old) or with renal impairment (eGFR<60) in people with T2D related to the percentage decrease in HbA1C, in Panama, Salvador, Guatemala, and Honduras.

METHODS: An economic model was developed to analyze costs based on the occurrence of T2D associated ME. Clinical data for risk profile and incidence of ME were taken from the UKPDS. HbA1C reduction was taken from the BRIGHT clinical trial. The outcomes included were: Myocardial Infarction [MI], Stroke, and Heart Failure [HF] resulting from risk profile including the HbA1C percentage reduction of each therapy. The analysis was made for a hypothetical cohort of 10,000 people in each country for a 1-year time horizon. All costs are expressed in 2022 USD$.

RESULTS: For renal impairment people, HbA1c reduction of 1.72% with Gla-U300 and 1.30% with IDeg-U100 was reported, whereas, in the older population, a reduction of 1.58% for Gla-U300 and 1.20% for IDeg-U100 was reported.

On average, for the analysis countries, treatment costs of $12,428,250 ($10,512,000-$14,892,000) for Gla-U300 and $14,371,875 ($13,687,500-$15,877,500) for IDeg-U100 were estimated. Average ME costs were $22,894 for MI, $23,633 for Stroke, and $6,293 for HF. By using Gla-U300 in both populations ME costs decrease around 5.44%-6.00%.

For renal impairment people, total cost with Gla-U300 was $20,404,269 ($18,488,019-$22,868,019) and $22,856,754 ($21,843,879-$23,048,379) with IDeg-U100, for a 10.76% (6.25%-19.79%) difference.

For older people, total cost with Gla-U300 was $20,570,389 ($18,654,139-$23,034,139) and $22,982,643 ($21,969,768-$24,488,268) with IDeg-U100, for a 10.52% (6.03%-19.50%) difference.

CONCLUSIONS: Gla-U300 results in lower ME costs compared to IDeg-100. With T2D renal impairment and older populations growing, improving cardiovascular risk by reducing HbA1c in T2D people is critical to avoid costs for the healthcare system.