Once‐weekly insulin icodec versus once‐daily insulin degludec for type 2 diabetes in China: A cost‐utility and budget impact analysis

AIMS: Insulin icodec, the first once-weekly basal insulin analogue, was approved in China in 2024. Although it has demonstrated robust clinical efficacy, its budget impact remains unknown, and the long-term cost-utility within the reimbursement context needs further estimates. This study evaluated the long-term cost-utility of once-weekly insulin icodec compared with once-daily insulin degludec in China. MATERIALS AND METHODS: We used the validated IHE Diabetes Cohort Model to simulate lifetime costs and health outcomes for insulin-naive Chinese patients with type 2 diabetes, based on the Chinese subgroup of the ONWARDS 3 trial. The model incorporated diabetes-related microvascular and macrovascular complications, with a 40-year time horizon and 5% annual discount rate. Costs and utilities were derived from the 2024 national reimbursement drug list, the national insulin volume-based procurement policy, and published literature, expressed in 2024 US dollars. Analyses were conducted from the Chinese healthcare system perspective. Robustness was assessed through one-way and probabilistic sensitivity analyses. A complementary budget impact analysis (BIA) estimated national-level financial implications under different reimbursement scenarios. RESULTS: Compared with degludec, icodec increased life expectancy by 0.025 years and yielded a gain of 0.216 quality-adjusted life-years (QALYs), while reducing costs by $1450.73. One-way sensitivity analyses showed incremental QALYs ranging from 0.065 to 0.464 and cost savings from $ 265.84 to $4166.30. Probabilistic sensitivity analysis confirmed mean gains of 0.212 QALYs and cost reductions of $1320.46. The BIA estimates estimated annual savings of $1.17 million, $2.35 million, and $2.58 million in 2025, 2026, and 2027, following the reimbursement of icodec. CONCLUSIONS: Within the current reimbursement context in China, once-weekly icodec is a dominant strategy compared with degludec, offering greater health benefits at a lower cost for patients with type 2 diabetes and generating potential annual savings.