NICE (UK) positive for Onswik for treating type 2 diabetes – Eli Lilly

Insulin efsitora alfa can be used, within its marketing authorisation, as an option to treat type 2 diabetes in adults.
Use the least expensive option of the suitable treatments (including insulin efsitora alfa and basal insulin intended for administration once or twice a day), having discussed the advantages and disadvantages of the available treatments with the person with the condition. Take account of administration costs, dosages, price per dose and commercial arrangements.

Why these recommendations were made: Treatment for type 2 diabetes is individualised and depends on blood sugar levels and any other health conditions. After trying metformin and an SGLT2 inhibitor, insulin-based treatment may be added. NICE’s guideline on managing type 2 diabetes in adults recommends basal insulin once or twice a day as initial insulin-based treatment. Insulin efsitora alfa is a once-weekly basal insulin that works in a similar way to other basal insulins and would be offered to the same population. Once-weekly insulin efsitora alfa may particularly benefit people who: i) need help to take their insulin or additional support to follow their treatment plan, for example, if they: a) are frail; b) have a learning disability; c) have problems with manual dexterity, or d) have a visual, cognitive or sensory impairment, and ii) find it difficult to take insulin daily, for example, if they have early-onset type 2 diabetes and are of working age.

Clinical trial evidence shows that insulin efsitora alfa is as effective at controlling blood glucose levels as 2 other basal insulins (insulin degludec and insulin glargine) both at the 100-unit concentration level, over 26 to 52 weeks. But the people who would benefit most from once-weekly insulin are underrepresented in the trials. This adds to the uncertainty about the treatment effect, but including these people in the trials would be difficult. Overall, the evidence can be applied to people having treatment in the NHS. The biggest cost saving from using insulin efsitora alfa comes from people needing less support to take their insulin. This is because insulin efsitora alfa is taken once a week rather than every day. An average of 1 hour with a specialist district nurse for diabetes is assumed each time a person needs help taking insulin. But the amount of help a person needs may vary. The impact of this has not been fully explored in different scenarios, which adds uncertainty to the results. A cost comparison suggests that overall costs for insulin efsitora alfa are similar to or lower than overall costs for basal insulin intended for administration once or twice a day, assuming that:

• i) the health benefits of insulin efsitora alfa are similar to other basal insulins, and ii) some people need help to take their insulin. So, insulin efsitora alfa can be used.