OBJECTIVES: Cost-effectiveness analysis was conducted to estimate the monthly incremental cost of switching from basal insulin + oral antidiabetics (OADs) ± GLP-1 receptor agonist (GLP1-RA) to IDegLira based therapy and incremental monthly cost to achieve HbA_1c reduction in 6 months after the switch.

METHODS: The analysis was developed under the perspective of patients (out of pocket) with type 2 diabetes (T2D) in Brazil with a treatment algorithm created using local and international guidelines. Monthly costs of basal insulins + OADs were calculated considering the usual dose of reference drugs (an alternative drug was used if reference not available) according to guidelines and drug labels. Evidence from real-world study EXTRA were used to support insulin and GLP1-RA doses before IDegLira treatment, IDegLira dose and HbA1c difference 6 months after the switch. The incremental cost-effectiveness ratio (ICER) was calculated to obtain the incremental monthly cost to achieve at least a 0.5% reduction in HbA_1c after 6 months of IDegLira treatment.

RESULTS: Over 16.000 drug regimens were simulated. A monthly economy of R$ 812.90 to an ICER of R$ 366.67 per month was observed. Complex regimens (≥4 OADs + insulin glargine U100), in which the discontinuation or dose reduction of DDP-4i, sulfonylurea and pioglitazone is advisable, demonstrated a dominant profile for IDegLira (more effective and lower cost) in 243 of 366 of evaluated treatments. Monthly costs reduction ranged from R$ 2.28 to R$ 309.08 in these cases with a monthly ICER varying from -R$ 1,26 to -R$ 171,71. Monthly ICER for remaining cases varied from R$ 4.26 to R$ 137.08.

CONCLUSIONS: IDegLira can be a cost-effective treatment for T2D in Brazil, improving HbA_1C levels and reducing costs. In patients treated with insulin glargine U100 and ≥4 OADs, the switch to IDegLira has shown to be cost saving in 66% of the evaluated regimens.