Cost‐utility of once‐weekly insulin icodec versus once‐daily basal insulins for type 2 diabetes in China

Objective To comprehensively assess the cost‐utility of icodec, the first once‐weekly basal insulin, at 700 and 1050 U formulations compared with once‐daily basal insulin analogues in Chinese adults with type 2 diabetes within reimbursement context. Methods A long‐term cost‐utility analysis was performed using ONWARDS 5 data from the perspective of the Chinese healthcare system. Icodec (700 and 1050 U) was compared with once‐daily insulin glargine U100, glargine U300, and degludec over a 40‐year time horizon, applying a 5% annual discount rate. Outcomes included diabetes‐related complications, costs, and quality‐adjusted life‐years (QALYs). Sensitivity and scenario analyses were conducted to evaluate robustness and individual comparator results. Results Compared with once‐daily basal insulin analogues, icodec was associated with reduced cardiovascular mortality (RR = 0.97) and lower cumulative incidence of microvascular and macrovascular complications. Icodec yielded an additional 0.261 QALYs and increased life expectancy by 0.031 years, while reducing total costs by $2544.93 (700 U) and $2,916.92 (1050 U). Cost savings were primarily driven by fewer hypoglycemia events. Probabilistic sensitivity analysis showed 100% cost‐effectiveness at below 0.4 times China's GDP per capita. Across all scenario analyses, icodec was projected to be cost‐saving or cost‐effective over a lifetime horizon compared with once‐daily basal insulin comparators. Conclusions Once‐weekly icodec represents a cost‐effective and clinically beneficial alternative to once‐daily basal insulin analogues for Chinese adults with type 2 diabetes within the current reimbursement framework.