OBJECTIVES

: To assess the cost-effectiveness of lixisenatide combined with basal insulin (BI) versus intensive premixed insulin (premix), BI plus prandial insulin with the main meal (basal-plus) or progressively covering all meals (basal-bolus) in patients with type 2 diabetes mellitus (T2DM) inadequately controlled by BI in China.

METHODS

: The IQVIA CORE Diabetes Model was used to estimate the clinical outcomes and costs for cohorts of patients with T2DM inadequately controlled by BI in China over a lifetime from the healthcare system perspective. Clinical data were based upon a systematic review and network meta-analysis that compared efficacy and safety of lixisenatide in combination with BI versus insulin regimens. Costs associated with treatment and complications were derived from published literature and inflated to 2017 Chinese Yuan (CNY). Transition probabilities, risk adjustments and the progression of complication risk factors were derived from published literature (e.g. UK Prospective Diabetes Study). Future costs and clinical benefits were discounted at 3% per annum. One-way and probability sensitivity analyses were performed.

RESULTS

: Lixisenatide in combination with BI was associated with incremental benefit of 0.123 quality-adjusted life years (QALYs) and an increased cost of CNY 11,686 compared with premixed insulin. Assuming the willingness-to-pay threshold was set at 3 times GDP per capita in China (CNY 178,980), lixisenatide combined with BI is a cost-effective option with an incremental cost-effectiveness ratio (ICER) of CNY 95,397 per QALY gained. Lixisenatide combined with BI was also cost-effective compared with basal-plus and basal-bolus therapies with ICERs of CNY 58,058/QALY gained and CNY 60,567/QALY gained, respectively. Sensitivity analyses confirmed the robustness of the results.

CONCLUSIONS

: Lixisenatide combined with BI is a cost-effective treatment alternative for patients with T2DM inadequately controlled by BI in China, compared with premixed insulin, basal plus and basal-bolus.