Cost-Effectiveness of Once-Weekly Insulin Icodec versus Daily Basal Insulins in Chinese Adults with T2DM: A Treatment-Background Stratified Analysis

Zeyu Xie,1 Weishang Deng,2 Zhuoru Liang,1 Yilin Xie,1 Jisheng Chen,3 Weiling Cao1 1Department of Pharmacy, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, Guangdong Province, People’s Republic of China; 2School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China; 3Key Specialty of Clinical Pharmacy, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong Province, People’s Republic of ChinaCorrespondence: Weiling Cao, Department of Pharmacy, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, Guangdong Province, 518001, People’s Republic of China, Email [email protected]: This study evaluated the long-term cost-effectiveness of once-weekly insulin icodec versus daily basal insulins in Chinese adults with type 2 diabetes mellitus (T2DM) across treatment backgrounds (insulin-naïve to basal-bolus users).Methods: Using the UKPDS-OM2.1 model calibrated to ONWARDS trial data (1– 5), we simulated lifetime outcomes over a 40-year horizon. Cost-utility analyses incorporated direct healthcare costs, complication utilities. Uncertainties were addressed using one-way and probabilistic sensitivity analyses. Scenario analyses explored pricing thresholds and adherence assumptions.Results: Insulin icodec demonstrated cost-effectiveness versus degludec in insulin-naïve populations (ICER=$24974.29, below China’s 3 times WTP threshold) but not versus glargine U100 (ICER=$45544.68) and once-daily basal insulin (ICER=$76877.59). For basal and basal-bolus insulin treated patients, insulin icodec does not offer long-term cost-effectiveness advantages over either insulin degludec and insulin glargine U100. One-way sensitivity analyses identified the simulation time horizon and discount rate as the most influential parameters, with probabilistic sensitivity analyses confirming the robustness of these findings. Scenario analyses demonstrated that insulin icodec’s would become cost-effective compared to basal insulins when patients were willing to pay an additional $150 annually.Conclusion: Insulin icodec offers cost-saving potential versus degludec in insulin-naïve T2DM patients. For basal and basal-bolus-treated patients, the clinical use of icodec needs to be critically evaluated for cost burden, and it is recommended that it be used preferentially in patients who are sensitive to the frequency of injections.Keywords: insulin icodec, insulin degludec, insulin glargine U100, cost-utility analysis, type 2 diabetes mellitus