LIBERTY claim analysis manuscript by Thomas Wilke and Sabrina Mueller

September 22, 2020

Research Scientists, Thomas Wilke and Sabrina Mueller recently published a manuscript on “Diabetes-Related Effectiveness and Cost of Liraglutide or Insulin in German Patients with Type 2 Diabetes: A 5-Year Retrospective Claims Analysis”.

As insulin and liraglutide are both treatment options for type 2 diabetes mellitus (T2DM), it was important to understand their long-term real-world outcomes. A retrospective study was conducted using administrative claims from a German health fund (AOK PLUS) and clinical data; the clinical data was collected in a disease management program. This claims data analysis, in adult patients with T2DM, investigated diabetes-related effectiveness and costs with long-term (up to five years) treatment with liraglutide or any insulin, in a real-world setting.

Continue reading this blog to learn about the unique insights that were gained during this project and get access to the publication.

Managing Type 2 Diabetes Mellitus

The global prevalence of type 2 diabetes mellitus is rising [1, 2] and has quadrupled in the last 3 decades [3]. In Germany, the current prevalence of diabetes is estimated to be between 7.2 and 9.9[4]. It is considered to be a significant disease burden and has been identified as the cause of several deaths.

Management of hyperglycaemia in T2DM focuses on lifestyle interventions such as diet and exercise, followed by pharmacological therapy, with metformin often being the first choice [5]. If this is insufficient, intensification with a second glucose-lowering drug is recommended [5–9]. Several second-line treatments are also available. Liraglutide is a GLP-1 analogue that stimulates insulin secretion in a glucose-dependent manner [10]. It is indicated for second-line treatment of patients with T2DM in combination with metformin and other oral antidiabetic drugs and/or insulin or as monotherapy if metformin cannot be tolerated or is contraindicated [11].

LIBERTY Study

To date, limited long-term data (>2 years) exist comparing real-world diabetes-related effectiveness and costs for liraglutide versus insulin treatment. The retrospective comparative analysis manuscript by Wilke and Mueller, compares the two treatments (Liraglutide and Insulin) in type 2 diabetes patients with respect to health-economic outcomes, based on five years of follow-up in German patients who were naive to either treatment prior to initiation. Propensity score matching and multivariable analysis methods were used in the study.

The aims of the study were to investigate differences in the development of clinical parameters (HbA1c, BMI and SBP), diabetes-related complications and long-term diabetes-related costs. Time to first diabetes-related hospitalization (diabetes as primary diagnosis, which also captured acute hypoglycaemic events) was also recorded.

The study demonstrated that clinical effectiveness achieved with liraglutide treatment was maintained for up to five years. Body mass index, systolic blood pressure and glycated haemoglobin levels improved with liraglutide treatment compared with insulin. The results also showed that Liraglutide treatment was associated with lower healthcare costs (outpatient, inpatient and medical aids). That translated into a mitigating effect on higher drug cost of Liraglutide so that overall cost of Liraglutide and insulin patients were similar.

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Read the Manuscript 

References:

[1] Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care. 2011;34: 1249–57.

[2] Papier K, Jordan S, Dste C, et al. Incidence and risk factors for type 2 diabetes mellitus in transitional Thailand: results from the Thai cohort study. BMJ Open. 2016;6:e014102.

[3] Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14:88–98.

[4] Heidemann C, Scheidt-Nave C. Prevalence, incidence and mortality of diabetes mellitus in adults in Germany – a review in the framework of the Diabetes Surveillance. J Health Monit. 2017;2: 98–121.

[5] Pfeiffer AF, Klein HH. The treatment of type 2 diabetes. Dtsch Arztebl Int. 2014;111:69–81.

[6] Amanda S, Butcher R. Sodium-glucose co-transporter 2 inhibitors for the treatment of type 2 diabetes: a review of clinical effectiveness, costeffectiveness, and guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019. https://www.ncbi.nlm.nih.gov/books/NBK545104/. Accessed 06 Nov 2019.

[7] DDG: Deutsche diabetes gesellschaft. National guidelines. https://www.deutsche-diabetesgesellschaft.de/leitlinien/evidenzbasierte-leitlinien.html. Accessed Dec 2019.

[8] Davies MJ, D’Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;2018(41):2669–701.

[9] Buse J, Wexler D, Tsapas A, et al. 2019 Update to: management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43:487–93.

[10] Vanderheiden A, Harrison LB, Warshauer JT, et al. Mechanisms of action of liraglutide in patients with type 2 diabetes treated with high-dose insulin. J Clin Endocrinol Metab. 2016;101:1798–806.

[11] Victoza summary of product characteristics. February 2018. https://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/001026/WC500050017.pdf. Accessed 06 Nov 2019.