A cost-controlling treatment strategy of adding liraglutide to insulin in type 2 diabetes

• Published in: Netherlands journal of medicine Vol. 75; no. 7; pp. 272 - 280
• Main Authors: de Wit, H M, Vervoort, G M M, de Galan, B E, Tack, C J
• Format: Journal Article
• Language: English
• Published: Netherlands 01-09-2017
• Subjects: Aged; Blood Glucose - analysis; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Drug Therapy, Combination - economics; Female; Glycated Hemoglobin A - analysis; Health Care Costs; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - economics; Insulin - administration & dosage; Insulin - economics; Liraglutide - administration & dosage; Liraglutide - economics; Male; Middle Aged; Treatment Outcome; Weight Loss - drug effects
• ISSN: 1872-9061

Addition of the GLP-1 receptor agonist liraglutide to insulin can reverse insulin-associated weight gain, improve HbA1c and decrease the need for insulin, but is expensive. From a cost perspective, such treatment should be discontinued when it is clear that treatment targets will not be achieved. Our aim was to find the best cost-controlling treatment strategy: the shortest possible trial period needed to discriminate successfully treated patients from those failing to achieve predefined targets of treatment success.
We used data from the 'Effect of Liraglutide on insulin-associated wEight GAiN in patients with Type 2 diabetes' (ELEGANT) trial, comparing additional liraglutide (n = 47) and standard insulin therapy (n = 24) during 26 weeks, to calculate the costs associated with different trial periods. Treatment success after 26 weeks was defined by having achieved ≥ 2 of the following: ≥ 4% weight loss, HbA1c ≤ 53 mmol/mol (7%), and/or discontinuation of insulin.
The additional direct costs of adding liraglutide for 26 weeks were € 699 per patient, or € 137 per 1 kg weight loss, compared with standard therapy. The best cost-controlling treatment strategy (identifying 21 of 23 responders, treating four non-responders) was to continue treatment in patients showing ≥ 3% weight loss or ≥ 60% decrease in insulin dose at 8 weeks, with a total cost of € 246 for this t rial period, saving € 453 in case of early discontinuation.
An 8-week trial period of adding liraglutide to insulin in patients with insulin-associated weight gain is an effective cost-controlling treatment strategy if the liraglutide is discontinued in patients not showing an early response regarding weight loss or insulin reduction.