OBJECTIVES: To evaluate the long-term cost effectiveness of insulin degludec/insulin aspart (IDegAsp) versus insulin glargine (IGlar) in the treatment of type 2 diabetes mellitus (T2DM) from a Chinese healthcare perspective.

METHODS: The validated and peer-reviewed IQVIA Core Diabetes Model was employed to simulate disease progression and determine the total direct medical cost, life years (LYs) and quality-adjusted life years (QALYs) over 30 years. Simulated cohorts and treatment effects were based on Onishi study (identifier in ClinicalTrials.gov: NCT01272193) which was a phase 3, open-label, randomized, parallel-group and multicenter trial among insulin-naïve patients with T2DM. The insulin prices were the averaged national drug procurement prices until December 2019 in China. Management and complication costs were obtained from Chinese published data and adjusted to the price level of 2018 with consumer price index. An annual discount rate of 5% was used for both costs and health outcomes. One-way and probabilistic sensitivity analyses were performed.

RESULTS: Most of the complications’ cumulative incidence in IDegAsp group was lower than IGlar (Myocardial infarction 35.31% vs.35.37%, Stroke 13.15% vs.13.23%; Ulcer 42.05% vs. 43.22%, Neuropathy 74.40% vs. 75.86%; Microalbuminuria 35.06% vs. 35.22%; Background diabetic retinopathy 32.63% vs. 33.09%, Macular edema 26.39% vs. 26.69%, Severe visual lost 11.44% vs.12.27%). Treatment with IDegAsp was associated with LYs gain of 0.150 (11.959 vs. 11.809) and QALYs gain of 0.188 (8.355 vs. 8.167) compared with IGlar over 30 years. IDegAsp saved CNY 22,282 for total cost than IGlar (CNY 196,545 vs. 218,827), which was mainly induced by lower treatment cost (CNY-14,937, CNY 66,128 vs. 81,065) and complication cost (CNY -7,364, CNY 120,840 vs. 128,204). Sensitivity analysis further demonstrated the robustness of the results.

CONCLUSIONS: Compared with IGlar, IDegAsp was a dominant treatment option for patients with T2DM in China, which obtained more LYs and QALYs, and reduced total direct medical cost.