OBJECTIVES : Nasal glucagon (NG) has efficacy similar to that of intramuscular glucagon (IMG) but is easier to administer, due to its unique mode of nasal delivery, and therefore more likely to be administered successfully during a severe hypoglycemic event (SHE) by non-medically trained caregivers. A cost-offset model was developed to evaluate short-term cost-offsets associated with introducing NG to the market, from the perspective of Medicare.

METHODS : Model development was informed by literature reviews, treatment practices for SHE and emergency care pathways in the US. The model is centered on a treatment pathway, covering treatment decisions and outcomes from SHE to post-event care. A treatment decision was defined as a choice (on how to care for the patient) by a person (caregiver, acquaintance, healthcare professional) confronted with a patient suffering from SHE. For each decision and outcome, probabilities were derived from the literature or based on expert judgement. Costs associated with decisions and outcomes were taken from Medicare Ambulance and Physician fee schedules and published sources, assumed NG and IMG at USD 280 (current Glucagon list price). The cost-offset of NG versus IMG was calculated as the difference in mean per-SHE costs, from the perspective of Medicare.

RESULTS : From a Medicare perspective, mean costs per SHE were USD 1,459 if treatment was attempted with IMG, compared with only USD 489 if treatment was attempted with NG. The mean cost-offset/cost-saving for NG versus IMG was therefore USD 970 per SHE with treatment attempted. This cost-offset was due to lower average EM costs following NG treatment, which, given its usability advantage, was more likely than IMG to treat patients successfully and therefore avoid the need to use EM Services.

CONCLUSIONS : Given its higher likelihood of treatment success, NG is likely to be cost-saving versus IMG for the treatment of SHE in the US.

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