OBJECTIVES:

The study aims to assess the cost-utility of insulin glargine 300 units/ml (GLA-300) compared to insulin glargine 100 units/ml (GLA-100) and insulin degludec 100 units/ml (DEG-100) in patients with type 2 diabetes mellitus in Serbia.

METHODS:

A cost-utility model was developed to estimate differences in costs and clinical outcomes. The perspective of the analysis was that of a healthcare payer in Serbia within one year time horizon. Main outcome was incremental cost-effectiveness ratio (ICER) expressed in dinars (RSD) per quality adjusted life years (QALYs). Costs considered were drug costs and costs of treating hypoglycaemia. Insulin dosages used per each of the comparators relied on pooled analysis of EDITION 1-2-3 clinical trials. Efficacy in the model was analysed based on comparators’ impact on: incidence of hypoglycaemic events, body mass index and dosage flexibility. Changes of these parameters were cited from EDITION 1-2-3 for comparison with GLA-100, and from network meta-analysis for comparison with DEG-100. Probabilistic sensitivity analysis (PSA) was conducted to test the model robustness.

RESULTS:

In the base case analysis, GLA-300 was associated with incremental QALYs compared to GLA-100 and DEG-100 estimated at 0.0082 and 0.0112, respectively. Total costs associated with GLA-300 were higher than those of GLA-100 (+RSD3,714.9) and lower than those of DEG-100 (-RSD35,560.7). In comparison with GLA-100, the estimated ICER was RSD 452,536/QALY, while in comparison with DEG-100, GLA-300 was pharmacoeconomically dominant as it obtains additional health gains with associated cost savings. At the 3xGDP/capita cost-effectiveness threshold, PSA estimated a probability of 66% and 93% for GLA-300 being cost-effective in comparison with GLA-100 and DEG-100, respectively.

CONCLUSIONS:

Based on a reduced incidence of hypoglycaemia and possibility for dose flexibility, GLA-300 is likely to be highly cost effective in economic and clinical conditions of Serbia in comparison to GLA-100 and pharmacoeconomically dominant in comparison to DEG-100.