OBJECTIVES:

The Dapagliflozin Evaluation in Patients With Inadequately Controlled Type 1 Diabetes (DEPICT-1) trial assessed the efficacy and safety of dapagliflozin as an adjunct to insulin in people with inadequately controlled type 1 diabetes mellitus (T1DM). The objective of this study was to estimate the cost-effectiveness of dapagliflozin (5mg or 10mg) versus placebo for people with T1DM in the UK setting.

METHODS:

A cost-utility analysis was undertaken from the UK payer perspective using the Cardiff Type 1 Diabetes Model and 24-week data from the DEPICT-1 trial. Treatment effects (reduction in HbA1c, weight and incidence of hypoglycaemia) were maintained for a lifetime unless discontinuation occurred, after which all treatment effects were reversed. Cost and utility data were sourced from the published literature and discounted at 3.5% per annum to estimate the impact of intervention-based resource use and incidence of diabetes-related complications on lifetime costs and quality-adjusted life years (QALYs).

RESULTS:

Over a lifetime horizon, total costs associated with dapagliflozin (5mg), dapagliflozin (10mg) and placebo, were £47,330, £47,578 and £42,118 per person, respectively. The incremental cost of dapagliflozin treatment was partially offset by the avoidance of hypoglycaemia and microvascular complications. Dapagliflozin was associated with improved life expectancy of 15.95 years (5mg or 10mg) versus 15.75 years with placebo and improved QALYs of 11.76 (5mg) or 11.77 (10mg) versus 11.37 per person with placebo. Corresponding incremental cost-effectiveness ratios were £13,449 and £13,896 per QALY gained for dapagliflozin 5mg and 10mg, respectively, as an add-on to insulin versus placebo.

CONCLUSIONS:

This analysis of 24-week DEPICT-1 data suggests that at commonly applied willingness-to-pay thresholds in a UK setting, dapagliflozin in combination with insulin would be a cost-effective treatment for people with T1DM whose insulin regimen does not provide sufficient glycaemic control.