The cost-effectiveness of dulaglutide versus insulin glargine for the treatment of type 2 diabetes mellitus in Japan.
AIMS
Dulaglutide is a new once weekly glucagon-like peptide-1 (GLP-1) receptor agonist administered via a disposable auto-injection pen for the management of type 2 diabetes mellitus (T2DM). The objective of this study was to estimate the cost-effectiveness of dulaglutide vs insulin glargine for the management of T2DM from a Japanese healthcare perspective, in accordance with recently approved Japanese Cost-Effectiveness Guidelines.


METHODS
The IQVIA CORE Diabetes Model (version 9) was used to estimate the long-term costs and effects of treatment with dulaglutide and insulin glargine. Direct comparative data from the Araki 2015 trial (NCT01584232) was used to inform the analysis. Costs associated with treatment and complications were derived from Japanese sources wherever possible and inflated to 2015 Japanese Yen (JPY). Utilities were based upon a European systematic review of diabetes utilities and adjusted for use in a Japanese population. One-way and probabilistic sensitivity analyses (OWSA and PSA) were conducted on all inputs and key modeling assumptions.


RESULTS
Dulaglutide 0.75 mg was associated with higher quality-adjusted life years (QALYs), life years (LYs), and total costs, compared to insulin glargine, resulting in an incremental cost-effectiveness ratio (ICER) of 416,280 JPY/QALY gained. Treatment with dulaglutide increased the time alive and free from diabetes-related complications by 4 months. OWSA and PSA indicated that results were robust to plausible variations in input parameters and modeling assumptions.


LIMITATIONS
Key limitations of this study are similar to other cost-utility analyses of diabetes, including the extrapolation of short-term clinical trial data into lifelong durations. In addition, due to the lack of robust published Japanese data, some values were derived from non-Japanese sources.


CONCLUSIONS
This analysis suggests that dulaglutide 0.75 mg may be a cost-effective treatment alternative to insulin glargine for patients with T2DM in Japan.
['Ishii|Hitoshi|H|', 'Madin-Warburton|Matthew|M|', 'Strizek|Alena|A|', 'Thornton-Jones|Lucy|L|', 'Suzuki|Shuichi|S|']
D000328:Adult D000368:Aged D015992:Body Mass Index D003362:Cost-Benefit Analysis D048909:Diabetes Complications D003924:Diabetes Mellitus, Type 2 D018450:Disease Progression D005260:Female D004763:Glucagon-Like Peptides D006442:Glycated Hemoglobin A D015438:Health Behavior D005102:Health Expenditures D006801:Humans D007004:Hypoglycemic Agents D007141:Immunoglobulin Fc Fragments D000069036:Insulin Glargine D007564:Japan D008017:Life Expectancy D008055:Lipids D008297:Male D008875:Middle Aged D017059:Models, Econometric D011788:Quality of Life D019057:Quality-Adjusted Life Years D011993:Recombinant Fusion Proteins
cost-effectiveness dulaglutide insulin glargine Type 2 diabetes Japan