Glucagon nasal powder (Baqsimi) is indicated for the treatment of severe hypoglycemia (SH) reactions that may occur in the management of insulin-treated patients with diabetes mellitus, when impaired consciousness precludes oral carbohydrates. It is supplied as a single use nasal dosing device containing a 3 mg single dose at a price of $131.60. The recommended dose is one spray in either nostril. According to the clinical expert consulted by CADTH, the treatment is prescribed to patients in preparation for an emergency involving the Health Canada (HC)-indicated SH event.
The sponsor submitted a cost-utility analysis (CUA) based on a decision tree comparing the availability of intranasal glucagon with intramuscular (IM) glucagon for a bystander who noticed a patient experiencing the HC-indicated SH event. The sponsor modelled costs and health consequences arising from a single SH event managed with a single glucagon treatment over a one-year time horizon. The SH event was assumed to be witnessed by a bystander (either a caregiver or an acquaintance) who may decide to administer intranasal or IM glucagon in response. Whether glucagon treatment was attempted and was successful determined related events and health care resource use. A range of events of varying severity were captured, including potential resolution of an SH event without health care resource use; SH event resolution requiring emergency medical service (EMS), emergency department (ED) visit, or inpatient admission; and SH event follow-up care. A bystander with access to intranasal was assumed to be twice as likely to attempt administration of intranasal glucagon to the patient experiencing an SH event compared with attempting administration with IM glucagon. The probabilities of a successful full dose administration for intranasal and IM glucagon were based on the sponsor’s treatment performance study of caregivers and other bystanders to a simulated SH event. The efficacy of successfully administered intranasal and IM glucagon was assumed to be equivalent, based on the sponsor’s claim that noninferior efficacy was demonstrated in the sponsor’s IGBC and IGBB studies. Other parameters were based on Canadian sources and were assumed to be the same between the intranasal glucagon and IM glucagon. Mortality and adverse events were not modelled.
In the sponsor’s base case, intranasal glucagon was associated with 0.001 incremental quality-adjusted life-years (QALYs) and cost savings of $382 compared with IM glucagon. At a willingness-to-pay threshold of $50,000 per QALY, intranasal glucagon had a 67% probability of being cost-effective compared with IM glucagon.
Version: Final (with redactions)
Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec.
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