Background: Nasal glucagon [NG] is a compact, portable, ready-to-use nasal spray for the treatment of severe hypoglycemic events [SHE] via intranasal absorption. Current treatment with intramuscular glucagon [IMG] requires multiple steps to administer, including reconstitution, and is difficult to administer for caregivers or passersby. Due to its mode of administration, NG has been demonstrated to result more often in successful (full-dose) administration of glucagon than IMG. The advantage of NG is expected to reduce payer costs due to less use of emergency services, including more treat and release, fewer ambulance trips and fewer emergency department visits.

Objective: Model 2-year budget impact of different scenarios of current (IMG, no kit) vs. future intervention mix (NG, IMG, no kit).

Methods: Populations defined by diabetes type, age and treatment were assessed using population-specific SHE incidence and mortality data. Budget impact was calculated from the U.S. Medicare perspective, with cost data sourced from literature and fee schedules. For adults with type 1 diabetes, an incidence of 366 SHEs per 1,000 person-years and a kit ownership proportion of 60% were assumed. Of patients with kits, 20% and 30% were assumed to own NG kits in the first and second year, respectively. Both NG and IMG kits were modeled using current glucagon list price. All model inputs were varied in sensitivity analyses.

Results: Reduced spending on SHE with the new mix was observed in all modeled populations with higher cost-savings in populations at higher risk of SHE. For 10,000 adults with type 1 diabetes, Medicare pays USD 11.7 million with the current mix and would pay USD 10.6 million for the new mix over 2 years. Savings with NG resulted from reductions in emergency services due to a higher probability of successful SHE treatment by caregivers or passersby.

Conclusions: NG as a treatment option for SHE is associated with substantial cost savings for U.S. payers.


B. Mitchell: Stock/Shareholder; Spouse/Partner; Eli Lilly and Company. J. Poehlmann: Consultant; Self; Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Roche Pharma, UCB, Inc. B. Osumili: Employee; Self; Eli Lilly and Company. S.K. Bajpai: Employee; Self; Eli Lilly and Company. W.J. Valentine: Consultant; Self; Air Liquide, Astellas Pharma US, Inc., Edwards Lifesciences, Janssen Pharmaceuticals, Inc., Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Roche Pharma, UCB, Inc..

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at