OBJECTIVES: Dulaglutide, a once weekly (QW) administered glucagon-like peptide 1 receptor agonist (GLP-1 RA) treatment for T2DM patients, will soon be entering the China market. The objective of this study was to assess the cost-effectiveness (CE) of dulaglutide 1.5 mg QW versus liraglutide 1.8 mg once daily (QD) in China.

METHODS: The validated IQVIA CORE diabetes model evaluated long-term clinical and economic outcomes of dulaglutide 1.5 mg QW and liraglutide 1.8 mg QD using a national payer perspective over a life-time horizon (40 years). Analyses were conducted according to Chinese pharmaco-economic guidelines. Simulated cohorts and treatment effects were derived from the AWARD-6 trial, where both interventions were combined with metformin. As the price of dulaglutide is not yet known, a number of price scenarios were analysed against the liraglutide National Reimbursed Drug List (NRDL) price. Published Chinese diabetes management, utilities and complication cost inputs were included, and sensitivity analyses performed.

RESULTS: At a 40% premium to the liraglutide 1.8mg QD reimbursed price, dulaglutide 1.5mg QW generated a highly cost effective Incremental Cost-Effectiveness Ratio (ICER) of 50,926 Chinese Yuan (CNY)/ quality of life year (QALY) gained. Lifetime projections demonstrated that dulaglutide was associated with lower cumulative incidences of diabetes complications, improved long-term health outcomes and an incremental 0.071 QALY when compared with liraglutide. Dulaglutide lifetime treatment costs were 3590 CNY higher than liraglutide, which were partially offset by cost-savings from avoided complications. Results were driven by HbA1c, drug costs and dulaglutide utility gains from the QW dose frequency, and device, through reduced needle handling. Sensitivity analyses demonstrated the robustness of results.

CONCLUSIONS: As the ICER generated was less than the willingness-to-pay cost-effectiveness threshold of 1 x GDP per capita/QALY gained (62,921 CNY), results suggest that dulaglutide 1.5 mg QW would be a highly cost-effective treatment if reimbursed on the China NRDL.