Cost of Severe Hypoglycemia and Budget Impact with Nasal Glucagon in Patients with Diabetes in Spain

Beatrice Osumili; Esther Artime; Beth Mitchell; Miriam Rubio-de Santos; Silvia Díaz-Cerezo; Marga Giménez; Erik Spaepen; Helen Sharland; William J Valentine

doi:10.1007/s13300-022-01238-8

Cost of Severe Hypoglycemia and Budget Impact with Nasal Glucagon in Patients with Diabetes in Spain

Diabetes Ther. 2022 Apr;13(4):775-794. doi: 10.1007/s13300-022-01238-8. Epub 2022 Mar 16.

Authors

Beatrice Osumili¹, Esther Artime², Beth Mitchell³, Miriam Rubio-de Santos², Silvia Díaz-Cerezo², Marga Giménez⁴, Erik Spaepen⁵, Helen Sharland⁶, William J Valentine⁷

Affiliations

¹ Eli Lilly and Company Limited, Bracknell, UK.
² Lilly España, Madrid, Spain.
³ Eli Lilly and Company, Indianapolis, USA.
⁴ Diabetes Unit, Endocrinology and Nutrition Department, IMDM, Hospital Clínic i Universitari de Barcelona, Barcelona, Spain.
⁵ HaaPACS GmbH, Schriesheim, Germany.
⁶ Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland.
⁷ Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland. valentine@ossianconsulting.com.

Abstract

Introduction: Severe hypoglycemic events (SHE) represent a clinical and economic burden in patients with diabetes. Nasal glucagon (NG) is a novel treatment for SHEs with similar efficacy, but with a usability advantage over injectable glucagon (IG) that may translate to improved economic outcomes. The economic implications of this usability advantage on SHE-related spending in Spain were explored in this analysis.

Methods: A cost-offset and budget impact analysis (BIA) was conducted using a decision tree model, adapted for the Spanish setting. The model calculated average costs per SHE over the SHE treatment pathway following a treatment attempt with IG or NG. Analyses were performed separately in three populations with insulin-treated diabetes: children and adolescents (4-17 years) with type 1 diabetes (T1D), adults with T1D and adults with type 2 diabetes (T2D), with respective population estimates applied in BIA. Treatment probabilities were assumed to be equal for IG and NG, except for treatment success following glucagon administration. Epidemiologic and cost data were obtained from Spanish-specific sources. BIA results were presented at a 3-year time horizon.

Results: On a per SHE level, NG was associated with lower costs compared to IG (children and adolescents with T1D, EUR 820; adults with T1D, EUR 804; adults with T2D, EUR 725). Lower costs were attributed to reduced costs of professional medical assistance in patients treated with NG. After 3 years, BIA showed that relative to IG, the introduction of NG was projected to reduce SHE-related spending by EUR 1,158,969, EUR 142,162,371, and EUR 6,542,585 in children and adolescents with T1D, adults with T1D, and adults with insulin-treated T2D, respectively.

Conclusions: In Spain, the usability advantage of NG over IG translates to potential cost savings per SHE in three populations with insulin-treated diabetes, and the introduction of NG was associated with a lower budget impact versus IG in each group.

Keywords: Budget impact; Cost-offset; Diabetes mellitus; Healthcare cost; Healthcare resource; Injectable glucagon; Insulin; Nasal glucagon; Severe hypoglycemia; Spain.