OBJECTIVES: The aim of this study was to assess the cost-effectiveness of insulin glargine/lixisenatide (iGlarLixi), a fixed-ratio co-formulation of insulin glargine and lixisenatide, compared with that of premixed insulin (comparator) for patients with basal insulin-uncontrolled type 2 diabetes (defined by a glycated hemoglobin [HbA1c] >7%) in South Korea.

METHODS: The CORE Diabetes Model, a validated and generic diabetes decision analytic model, was used with the following settings: horizon of 30 years, a health service perspective, and 3% discount rate for health outcomes and treatment costs. The treatment effects were sourced from an indirect treatment comparison via the common comparator of insulin glargine. Cost data were derived from a real-world claims data analysis. Each treatment was administered for the first 3 years, and then switched to basal-bolus (basal insulin + 3 times short acting insulin) from the 4^th year and on. Sensitivity analyses were conducted with varying key inputs.

RESULTS: The mean (standard deviation) age, baseline HbA1c, duration of disease, and body mass index (BMI) in the cohort were 64.4 (11.4) years, 8.6 (1.3) %, 18 (12) years, and 24.4 (3.3) kg/m, respectively. Indirect treatment comparisons showed that iGlarLixi resulted in significantly greater reduction from baselines for HbA1c and BMI compared with premixed insulin: -0.50% (95% confidence interval [CI]: -0.68, -0.32) for HbA1c and -0.80 kg/m (95% CI: -1.29, -0.31) for BMI. In the base analysis, iGlarLixi was found to be dominant (more effective and less costly) over premixed insulin with 0.079 additional quality-adjusted life-years and approximately 230 USD lower cost, and the incremental cost–utility ratios from sensitivity analyses also remained dominant or below 10,000 USD.

CONCLUSIONS: iGlarLixi showed dominance or acceptable incremental cost-effectiveness over premixed insulin. These outcomes suggest it could be a suitable alternative to insulin intensification, which is related to poor glycemic control and concerns about hypoglycemia and weight gain.