| Summary: | Xultophy -- insulin degludec and liraglutide injection (IDegLira) -- is a fixed-ratio combination of a long-acting basal human insulin analogue, insulin degludec, and a glucagon-like peptide 1 receptor agonist (GLP-1 RA), liraglutide. IDegLira is provided in a pre-filled pen containing 3 mL of solution equivalent to 300 U of insulin degludec and 10.8 mg of liraglutide. IDegLira is administered in units: 1 U dispensed from the pen contains 1 U of insulin degludec and 0.036 mg of liraglutide. IDegLira is recommended for use as follows: as an adjunct to lifestyle modifications, for the once-daily treatment of adults with type 2 diabetes mellitus to improve glycemic control in combination with metformin, with or without sulfonylurea, when these combined with basal insulin (less than 50 U daily) or liraglutide (less than or equal to 1.8 mg daily) do not provide adequate glycemic control. The current submitted price for IDegLira is $60.80 per 3 mL pre-filled pen. Depending on the daily dose (16 U to 50 U), this would lead to a daily cost of $3.42 to $10.13, or $1,184 to $3,699 annually. Liraglutide was previously reviewed by the CADTH Common Drug Review in 2011. CADTH's Canadian Expert Drug Advisory Committee (CEDAC) recommended that liraglutide "not be listed at the submitted price". The committee noted that a reduced price would increase the likelihood of a recommendation to "list with criteria" for patients with inadequate glycemic control on metformin and a sulfonylurea. In 2017, the CADTH Common Drug Review reviewed insulin degludec. The CADTH Canadian Drug Expert Committee recommended that insulin degludec be reimbursed similar to other long-acting insulin analogues that are reimbursed for the treatment of diabetes mellitus and that the overall drug plan cost should not exceed the treatment cost of the least costly long-acting insulin analogue. The manufacturer submitted a cost-utility analysis over a 40-year time horizon (referred to as a lifetime horizon)
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