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Meta-Analysis and Cost-Effectiveness Analysis of Insulin Glargine 100 U/mL Versus Insulin Degludec for the Treatment of Type 2 Diabetes in China.
Diabetes Ther. 2019 Oct; 10(5):1969-1984.DT

Abstract

INTRODUCTION

To evaluate the efficacy and safety as well as the long-term cost-effectiveness of insulin glargine 100 U/mL (IGlar) versus insulin degludec (IDeg) for the treatment of type 2 diabetes mellitus (T2DM) from the Chinese healthcare system perspective.

METHODS

A systematic search of English and Chinese electronic databases for randomized controlled trials (RCTs) comparing IGlar with IDeg for the treatment of T2DM was performed, followed by a meta-analysis to compare the efficacy and safety of IGlar versus IDeg. The CORE Diabetes Model was used to estimate lifetime costs, quality-adjusted life years (QALYs) gained, and cost-effectiveness of IGlar versus IDeg. One-way and probabilistic sensitivity analyses were conducted to assess the underlying parameter uncertainty.

RESULTS

Six RCTs were included in the meta-analysis. The IGlar group showed a statistically significant decrease in glycated hemoglobin (HbA1c) from baseline compared to the IDeg group (mean difference [MD] 0.08%, 95% confidence interval [CI] 0.01-0.14%, P = 0.02). Body mass index (BMI) control was numerically better in the IGlar group than in the IDeg group (MD 0.07 kg/m2, 95% CI - 0.01 to 0.14 kg/m2, P = 0.08). In terms of hypoglycemia, the incidence of non-severe overall hypoglycemia was comparable between the IDeg and IGlar patient groups (P > 0.05), while the incidence of non-severe nocturnal hypoglycemia (relative risk [RR 0.79], 95% CI 0.70-0.90, P < 0.01) and the event rates of non-severe overall (RR 0.91, 95% CI 0.85-0.97, P < 0.01) and non-severe nocturnal hypoglycemia (RR 0.91, 95% CI 0.85-0.97, P < 0.01) were lower in the IDeg group. The incidences and event rates of both severe overall and nocturnal hypoglycemia were similar for the two groups (P > 0.05). The cost-effectiveness analysis showed that IGlar is the dominant treatment option compared with IDeg, with a lifetime savings of 1004 Chinese yuan in direct medical costs and a net gain of 0.015 QALYs per patient. Both one-way and probabilistic sensitivity analyses confirmed the robustness of the results.

CONCLUSIONS

IGlar is a cost-saving option with incremental effectiveness compared with IDeg for the treatment of T2DM in China.

FUNDING

Sanofi China.

Authors+Show Affiliations

Health Economics Research Institute, Sun Yat-sen University, Guangzhou, China.Health Economics and Outcome Research, Sanofi, Shanghai, China.Shanghai Centennial Scientific, Shanghai, China.Shanghai Centennial Scientific, Shanghai, China.Shanghai Centennial Scientific, Shanghai, China.Health Economics Research Institute, Sun Yat-sen University, Guangzhou, China. xuanjw3@mail.sysu.edu.cn.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31482483

Citation

Su, Wen, et al. "Meta-Analysis and Cost-Effectiveness Analysis of Insulin Glargine 100 U/mL Versus Insulin Degludec for the Treatment of Type 2 Diabetes in China." Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders, vol. 10, no. 5, 2019, pp. 1969-1984.
Su W, Li C, Zhang L, et al. Meta-Analysis and Cost-Effectiveness Analysis of Insulin Glargine 100 U/mL Versus Insulin Degludec for the Treatment of Type 2 Diabetes in China. Diabetes therapy : research, treatment and education of diabetes and related disorders. 2019;10(5):1969-1984.
Su, W., Li, C., Zhang, L., Lin, Z., Tan, J., & Xuan, J. (2019). Meta-Analysis and Cost-Effectiveness Analysis of Insulin Glargine 100 U/mL Versus Insulin Degludec for the Treatment of Type 2 Diabetes in China. Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders, 10(5), 1969-1984. https://doi.org/10.1007/s13300-019-00683-2
Su W, et al. Meta-Analysis and Cost-Effectiveness Analysis of Insulin Glargine 100 U/mL Versus Insulin Degludec for the Treatment of Type 2 Diabetes in China. Diabetes therapy : research, treatment and education of diabetes and related disorders. 2019;10(5):1969-1984. PubMed PMID: 31482483.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meta-Analysis and Cost-Effectiveness Analysis of Insulin Glargine 100 U/mL Versus Insulin Degludec for the Treatment of Type 2 Diabetes in China. AU - Su,Wen, AU - Li,Chaoyun, AU - Zhang,Lei, AU - Lin,Ziyi, AU - Tan,Jun, AU - Xuan,Jianwei, Y1 - 2019/09/03/ PY - 2019/04/01/received PY - 2019/9/5/pubmed PY - 2019/9/5/medline PY - 2019/9/5/entrez KW - Cost-effectiveness KW - Insulin degludec KW - Insulin glargine KW - Meta-analysis KW - Type 2 diabetes SP - 1969 EP - 1984 JF - Diabetes therapy : research, treatment and education of diabetes and related disorders VL - 10 IS - 5 N2 - INTRODUCTION: To evaluate the efficacy and safety as well as the long-term cost-effectiveness of insulin glargine 100 U/mL (IGlar) versus insulin degludec (IDeg) for the treatment of type 2 diabetes mellitus (T2DM) from the Chinese healthcare system perspective. METHODS: A systematic search of English and Chinese electronic databases for randomized controlled trials (RCTs) comparing IGlar with IDeg for the treatment of T2DM was performed, followed by a meta-analysis to compare the efficacy and safety of IGlar versus IDeg. The CORE Diabetes Model was used to estimate lifetime costs, quality-adjusted life years (QALYs) gained, and cost-effectiveness of IGlar versus IDeg. One-way and probabilistic sensitivity analyses were conducted to assess the underlying parameter uncertainty. RESULTS: Six RCTs were included in the meta-analysis. The IGlar group showed a statistically significant decrease in glycated hemoglobin (HbA1c) from baseline compared to the IDeg group (mean difference [MD] 0.08%, 95% confidence interval [CI] 0.01-0.14%, P = 0.02). Body mass index (BMI) control was numerically better in the IGlar group than in the IDeg group (MD 0.07 kg/m2, 95% CI - 0.01 to 0.14 kg/m2, P = 0.08). In terms of hypoglycemia, the incidence of non-severe overall hypoglycemia was comparable between the IDeg and IGlar patient groups (P > 0.05), while the incidence of non-severe nocturnal hypoglycemia (relative risk [RR 0.79], 95% CI 0.70-0.90, P < 0.01) and the event rates of non-severe overall (RR 0.91, 95% CI 0.85-0.97, P < 0.01) and non-severe nocturnal hypoglycemia (RR 0.91, 95% CI 0.85-0.97, P < 0.01) were lower in the IDeg group. The incidences and event rates of both severe overall and nocturnal hypoglycemia were similar for the two groups (P > 0.05). The cost-effectiveness analysis showed that IGlar is the dominant treatment option compared with IDeg, with a lifetime savings of 1004 Chinese yuan in direct medical costs and a net gain of 0.015 QALYs per patient. Both one-way and probabilistic sensitivity analyses confirmed the robustness of the results. CONCLUSIONS: IGlar is a cost-saving option with incremental effectiveness compared with IDeg for the treatment of T2DM in China. FUNDING: Sanofi China. SN - 1869-6953 UR - https://www.unboundmedicine.com/medline/citation/31482483/Meta_Analysis_and_Cost_Effectiveness_Analysis_of_Insulin_Glargine_100_U/mL_Versus_Insulin_Degludec_for_the_Treatment_of_Type_2_Diabetes_in_China_ L2 - https://dx.doi.org/10.1007/s13300-019-00683-2 DB - PRIME DP - Unbound Medicine ER -
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