OBJECTIVES: Many modern treatments exist for type 2 diabetes (T2D), but insulin therapies (typically injected once-daily) are often eventually required due to innate disease progression. Insulin icodec is a basal insulin analog recently developed for once-weekly administration. This study aimed to evaluate the long-term cost-effectiveness of icodec versus three different basal insulin analogs in insulin-naïve patients with T2D in the UK.

METHODS: Long-term outcomes were projected over patients' lifetimes using the validated PRIME T2D Model. Baseline cohort characteristics and subgroup-specific treatment effects associated with insulins icodec, degludec, glargine U100 and glargine U300 were derived from a post-hoc analysis of the ONWARDS 5 clinical trial. Patients were modelled to receive basal insulin for 4 years before intensifying with bolus insulin. A UK-specific disutility relating to once-daily versus once-weekly injection was taken from a published time-trade-off study and applied until intensification. Health-state utilities and UK-specific costs, expressed in 2022 GBP and accounted from a healthcare payer perspective, were sourced from published studies. The acquisition cost of icodec, currently unknown, was assumed equal to degludec.

RESULTS: Icodec improved quality-adjusted life expectancy by 0.21, 0.28 and 0.11 quality-adjusted life years (QALYs) compared with degludec, glargine U100 and glargine U300, respectively. Injection frequency and changes in glycated hemoglobin and systolic blood pressure were the key drivers of outcomes. Direct costs with icodec were estimated to be GBP 1,093 lower versus degludec, and GBP 253 and GBP 690 higher versus glargine U100 and glargine U300, respectively. Icodec was considered dominant versus degludec and associated with incremental cost-effectiveness ratios of GBP 904 and GBP 6,359 per QALY gained versus glargine U100 and U300, respectively, falling below the UK willingness-to-pay threshold of GBP 20,000 per QALY gained.

CONCLUSIONS: Icodec was projected to be a highly cost‐effective treatment compared with degludec, glargine U100 and glargine U300 in the UK.