2.3. Medication resource use and costs

Mean daily doses of 40.1 dose steps for IDegLira, 52.7 IU for insulin glargine U100 and 32.3 IU for insulin aspart were used, based on the DUAL VII trial.24 Injection frequency was once daily with IDegLira and 4‐times daily with insulin glargine U100 plus insulin aspart (1 dose of insulin glargine U100 plus 3 bolus doses of insulin aspart), as this was the most common dosing schedule in DUAL VII. Each injection was assumed to be performed by a single, new needle, as recommended by the Forum for Injection Technique (FIT).27 Patients receiving IDegLira were assumed to use 1 SMBG test per day, compared with 4 per day with BBT, as recommended in guidelines issued by Training, Research and Education for Nurses in Diabetes‐United Kingdom (TREND‐UK).28

All costs were accounted from a healthcare payer perspective in pounds sterling (GBP). Annual costs of medications (IDegLira, insulin glargine U100 and insulin aspart), needles, and SMBG testing were based on wholesale acquisition costs (Table ​(Table22).29 Direct costs associated with severe hypoglycaemic episodes were based on values reported by Hammer et al., inflated to 2016 values using the Hospital & Community Health Services (HCHS) index.30, 31 Direct costs associated with non‐severe hypoglycaemic episodes were calculated using healthcare resource use reported by Chubb and Tikkanen, with updated unit costs applied (from the Unit Costs of Health and Social Care by the Personal Social Services Research Unit [PSSRU]), and SMBG acquisition costs from MIMS UK.29, 31, 32 No costs were applied to changes in BMI.

Summary of unit costs used in the base case

Cost of non‐severe hypoglycaemia was calculated using a combination of sources.29, 31, 32 Cost of severe hypoglycaemia was calculated using data published by Hammer et al. and Curtis and Burns.30, 31

All pharmacy costs were sourced from MIMS UK in April 2018.29