@article{5311fb135cf94a94b875993703aa3352,
title = "DEVOTE 5: Evaluating the Short-Term Cost-Utility of Insulin Degludec Versus Insulin Glargine U100 in Basal–Bolus Regimens for Type 2 Diabetes in the UK",
abstract = "Introduction: The aim of this study was to evaluate the short-term cost-utility of insulin degludec (degludec) versus insulin glargine 100 units/mL (glargine U100) for the treatment of type 2 diabetes in the basal–bolus subgroup of the head-to-head cardiovascular (CV) outcome trial, DEVOTE. Methods: A cost-utility analysis was conducted over a 2-year time horizon using a decision analytic model to compare costs in patients receiving once daily degludec or glargine U100, both as part of a basal–bolus regimen, in addition to standard care. Clinical outcomes and patient characteristics were taken exclusively from DEVOTE, whilst health-related quality of life utilities and UK-specific costs (expressed in 2016 GBP) were obtained from the literature. The analysis was conducted from the perspective of the National Health Service. Results: Degludec was associated with mean cost savings of GBP 28.78 per patient relative to glargine U100 in patients with type 2 diabetes at high CV risk. Cost savings were driven by the reduction in risk of diabetes-related complications with degludec, which offset the higher treatment costs relative to glargine U100. Degludec was associated with a mean improvement of 0.0064 quality-adjusted life-years (QALYs) compared with glargine U100, with improvements driven predominantly by lower rates of severe hypoglycemia with degludec versus glargine U100. Improvements in quality-adjusted life expectancy combined with cost neutrality resulted in degludec being dominant over glargine U100. Sensitivity analyses demonstrated that the incremental cost-utility ratio was stable to variations in the majority of model inputs. Conclusion: The present short-term modeling analysis found that for the basal–bolus subgroup of patients in DEVOTE, with a high risk of CV events, degludec was cost neutral (no additional costs) compared with glargine U100 over a 2-year time horizon in the UK setting. Furthermore, there were QALY gains with degludec, particularly due to the reduction in the risk of severe hypoglycemia. Funding: Novo Nordisk A/S. Trial Registration: ClinicalTrials.gov identifier, NCT01959529.",
keywords = "Cardiovascular outcome trial, Cost, Cost-effective, Diabetes, Hypoglycemia, Insulin degludec, QALY, United Kingdom",
author = "{On Behalf Of The Devote Study Group} and Pollock, {Richard F.} and Valentine, {William J.} and Marso, {Steven P.} and Jens Gundgaard and Nino Hall{\'e}n and Hansen, {Lars L.} and Deniz Tutkunkardas and Buse, {John B.}",
note = "Funding Information: Medical Writing and Editorial Assis tance. Medical writing support was provided by Anna Campbell, Ph.D., and editorial assistance was provided by Beverly La Ferla, of Water-meadow Medical, an Ashfield company, part of UDG Healthcare plc, and was funded by Novo Nordisk. Funding Information: Disclosures. Richard F. Pollock is a full-time employee of Ossian Health Economics and Communications GmbH, which received consultancy fees from Novo Nordisk to construct the model and conduct the analyses. William J. Valentine is also a full-time employee of Ossian Health Economics and Communications GmbH, which received consultancy fees from Novo Nordisk to construct the model and conduct the analyses. Steven P. Marso has received personal fees from Abbott Vascular, Novo Nordisk, University of Oxford, AstraZeneca, and Bristol-Myers Squibb, and research support from Novo Nordisk, The Medicines Company, and Terumo Medical. Jens Gundgaard is an employee of Novo Nordisk and also holds shares/stocks in Novo Nordisk. Nino Hall{\'e}n is an employee of Novo Nordisk. Lars L. Hansen is an employee of Novo Nordisk. Deniz Tutkunkardas is an employee of Novo Nordisk. John B. Buse reports grant and consultation fees to the University of North Carolina (UNC) under contract and travel/meals/lodging for contracted activities from Novo Nordisk during the conduct of the study; grants and fees for consultation to UNC under contract and travel/ meals/lodging for contracted activities from Eli Lilly, GI Dynamics, Amylin, Orexigen, Merck, Novo Nordisk, Transtech Pharma, AstraZeneca, Takeda, Sanofi, and Lexicon; fees for consultation to UNC under contract and travel/ meals/lodging for contracted activities from Hoffmann-La Roche, Bristol-Myers Squibb, Liposcience, Elcelyx, Metavention, Dance Bio-pharm Inc, and Quest; grants from Medtronic Minimed, Tolerex, Osiris, Halozyme, Pfizer, Johnson & Johnson, Andromeda, Boehringer Ingelheim, GlaxoSmithKline, Astellas, MacroGenics, Intarcia Therapeutics, and Scion NeuroStim; stock options in PhaseBio outside the submitted work; and is or has been a member of a variety of nonprofit boards: American Diabetes Association, DiabetesSisters, Taking Control of Your Diabetes, AstraZeneca Healthcare Foundation, Bristol-Myers Squib Together on Diabetes Foundation, and the National Diabetes Education Program. Publisher Copyright: {\textcopyright} 2018, The Author(s).",
year = "2018",
month = jun,
day = "1",
doi = "10.1007/s13300-018-0430-4",
language = "English (US)",
volume = "9",
pages = "1217--1232",
journal = "Diabetes Therapy",
issn = "1869-6953",
publisher = "Springer Publishing Company",
number = "3",
}