Projecting the Long-Term Cost-Effectiveness of Once-Weekly Insulin Icodec Versus Once-Daily Basal Insulin Analogs in Italy Using the Prime T2D Model.
Icodec may be a cost-effective option for type 2 diabetes management in Italy, offering improved quality-adjusted life expectancy with less frequent dosing.
Where it sits
this study against the rest of the dulaglutide corpusSummary and findings
The study evaluated the long-term cost-effectiveness of once-weekly insulin icodec versus once-daily basal insulin analogs in insulin-naïve adults with type 2 diabetes in Italy. Using the PRIME T2D Model, outcomes were projected over patient lifetimes with a focus on quality-adjusted life years (QALYs) and cost-effectiveness ratios. Icodec showed improved QALYs and was deemed cost-effective despite higher acquisition costs.
Abstract
<h4>Background</h4>Icodec is the first once-weekly basal insulin for type 2 diabetes (T2D), potentially improving quality of life through a reduced administration burden versus once-daily basal insulins. This study assessed the long-term cost-effectiveness of icodec versus glargine U100, degludec and a mix of once-daily basal insulins (degludec, glargine U100 and glargine U300) in insulin-naïve adults with T2D in Italy.<h4>Methods</h4>Outcomes were projected over patient lifetimes (up to 60 years) using the PRIME T2D Model, discounted annually at 3.0%. Baseline characteristics and treatment effects were taken from ONWARDS 1, 3 and 5. Modelled patients received basal insulins for 4 years, before intensifying with the addition of bolus insulin. Treatment effects applied in the first year of the analysis and a utility benefit relating to once-weekly versus once-daily injection were maintained until intensification. Costs were expressed in 2024 euros (EUR) from the perspective of the Italian National Health Service.<h4>Results</h4>Icodec was associated with improved quality-adjusted life expectancy of 0.16 quality-adjusted life years (QALYs) versus glargine U100 and degludec, and 0.26 QALYs versus the once-daily insulin mix. Benefits primarily resulted from the reduced injection frequency with icodec. Higher acquisition costs with icodec were partially offset by reduced use of consumables and modelled reductions in diabetes-related complications. Icodec was associated with incremental cost-effectiveness ratios of EUR 25 623, EUR 5438 and EUR 3940 per QALY gained versus glargine U100, degludec and the once-daily insulin mix, respectively.<h4>Conclusions</h4>Icodec was projected to be cost-effective versus once-daily insulins for insulin-naïve people with T2D in Italy.
Background
The study addresses the need for cost-effective diabetes management options, particularly focusing on the potential benefits of reduced injection frequency with once-weekly insulin icodec. Prior research has suggested that less frequent dosing could improve patient adherence and quality of life. This study aims to project the long-term economic and health outcomes of icodec compared to traditional once-daily basal insulins in Italy.
Methods
The study used the PRIME T2D Model to project outcomes over patient lifetimes, up to 60 years. Baseline characteristics and treatment effects were sourced from the ONWARDS 1, 3, and 5 trials. Patients were modeled to receive basal insulins for 4 years before intensifying treatment with bolus insulin. Costs were calculated in 2024 euros from the Italian National Health Service perspective, with a 3.0% annual discount rate.
Results
Icodec was associated with an increase of 0.16 QALYs compared to glargine U100 and degludec, and 0.26 QALYs compared to a mix of once-daily insulins. The incremental cost-effectiveness ratios were EUR 25,623, EUR 5,438, and EUR 3,940 per QALY gained versus glargine U100, degludec, and the insulin mix, respectively. The benefits were primarily attributed to the reduced injection frequency.
Interpretation
The study suggests that icodec may offer a cost-effective alternative to once-daily basal insulins for insulin-naïve patients in Italy, primarily due to improved quality-adjusted life expectancy. However, the reliance on model projections and the specific Italian healthcare context limit the generalizability of these findings. The clinical significance of the QALY gains should be weighed against the higher acquisition costs.
Key findings
- 0.16 QALYs gained with icodec versus glargine U100 and degludec.
- 0.26 QALYs gained with icodec versus the once-daily insulin mix.
- EUR 25,623 per QALY gained versus glargine U100.
- EUR 5,438 per QALY gained versus degludec.
- EUR 3,940 per QALY gained versus the once-daily insulin mix.
Limitations
- Model-based projections, not clinical outcomes.
- Specific to Italian healthcare context.
- Higher acquisition costs for icodec.
- Utility benefit assumptions may not reflect real-world adherence.