Economic evaluation of insulin therapy intensification for effective and safe control of diabetes mellitus type 2

Insulin therapy is one of the effective methods of effective control of diabetes mellitus type 2 (T2DM) which can manage resistance to insulin. Insulin’s analogs have advantages in compare with human insulins in frames of safety (less amount of hypoglycemia, including severe). Safety profile can be improved with combination of basal insulin and glucagon-like peptide receptor-1 agonist (aGLP-1). Economic aspects of such kind treatment in compare with standard regimen of basal-bolus and basal plus for local conditions are not known yet.

Materials and methods. Economic parameters of the fixed combination of insulin glargine 100 Ul/ml plus lixisenatide (Soliqua SoloStar®) [Regimen 1] were calculated based on prognostic model of risk of T2DM complications, efficacy and safety. Comparison has been made with insulin glargine 100 Ul/ml + insulin glulisine [Regimen 2], insulin glargine 100 Ul/ml + insulin aspart [Regimen 3], insulin detemir + insulin aspart [regimen 4], insulin degludec + insulin aspart [Regimen 5]. Efficacy and safety has been prognosed in different time of model (1-5 years). Direct costs of out-patient treatment, hospitalization cost (complications of T2DM) as well as expenditures on severe hypoglycemia episodes and insulins in DDD were calculated. Published data of clinical trials and real world evidences were used.

Results. Results of T2DM control and prognosis of complications were practically similar in all regimens of therapy. The different rates of hypoglycemia including severe were found for regimens: Regimen 1 — 3,03 и 0,02 events/patient-year; Regimen 2 — 4,1 и 2,3; Regimen 3 — 16,4 и 2,3; Regimen 4 — 9,5 и 2,3 %; Regimen 5 — 11,6 — 0,47 accordingly. Regimen 5 had a highest utilitarian cost based on DDD. Total direct costs, including all expenditures was less in Regimen 1 — 73 956 RUR/patient/year. In the same time expenditures for Regimen 2 were 93 258 RUR, for 3 — 92 289 RUR, for 4 — 87 598 RUR, for 5 — 79 396 RUR.

Conclusion. Fixed dose combination Soliqua SoloStar® is an economic proven strategy for effective control of T2DM in compare with basal-bolus and basal plus regimens of insulin therapy.

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