scholarly journals Choice across 10 pharmacologic combination strategies for type 2 diabetes: a cost-effectiveness analysis

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Shuyan Gu ◽  
Lizheng Shi ◽  
Hui Shao ◽  
Xiaoyong Wang ◽  
Xiaoqian Hu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Chinese Patients ◽  
Oral Drug ◽  
System Perspective ◽  
Treatment Comparison ◽  
Combination Strategies ◽  
Life Years ◽  
The Cost

Abstract Background Clinical guidelines recommend a stepped-escalation treatment strategy for type 2 diabetes (T2DM). Across multiple treatment strategies varying in efficacy and costs, no clinical or economic studies directly compared them. This study aims to estimate and compare the cost-effectiveness of 10 commonly used pharmacologic combination strategies for T2DM. Methods Based on Chinese guideline and practice, 10 three-stepwise add-on strategies were identified, which start with metformin, then switch to metformin plus one oral drug (i.e., sulfonylurea, thiazolidinedione, α-glucosidase inhibitor, glinide, or DPP-4 inhibitor) as second line, and finally switch to metformin plus one injection (i.e., insulin or GLP-1 receptor agonist) as third line. A cohort of 10,000 Chinese patients with newly diagnosed T2DM was established. From a healthcare system perspective, the Cardiff model was used to estimate the cost-effectiveness of the strategies, with clinical data sourced from a systematic review and indirect treatment comparison of 324 trials, costs from claims data of 1164 T2DM patients, and utilities from an EQ-5D study. Outcome measures include costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefits (NMBs). Results Over 40-year simulation, the costs accumulated for a patient ranged from $7661 with strategy 1 to $14,273 with strategy 10, while the QALY gains ranged from 13.965 with strategy 1 to 14.117 with strategy 8. Strategy 7 was dominant over seven strategies (strategies 2~6, 9~10) with higher QALYs but lower costs. Additionally, at a willingness-to-pay threshold of $30,787/QALY (i.e., 3 times GDP/capita for China), strategy 7 was cost-effective compared with strategy 1 (ICER of strategy 7 vs. 1, $3371/QALY) and strategy 8 (ICER of strategy 8 vs. 7, $132,790/QALY). Ranking the strategies by ICERs and NMBs, strategy 7 provided the best value for money when compared to all other strategies, followed by strategies 5, 9, 8, 1, 3, 6, 10, 2, and 4. Scenario analyses showed that patients insist on pharmacologic treatments increased their QALYs (0.456~0.653) at an acceptable range of cost increase (ICERs, $1450/QALY~$12,360/QALY) or even at cost saving compared with those not receive treatments. Conclusions This study provides evidence-based references for diabetes management. Our findings can be used to design the essential drug formulary, infer clinical practice, and help the decision-maker design reimbursement policy.

scholarly journals Cost–effectiveness analysis of empagliflozin compared with glimepiride in patients with Type 2 diabetes in China

2021 ◽  
Author(s):  
Ahmed Salem ◽  
Peng Men ◽  
Mafalda Ramos ◽  
Yan-Jun Zhang ◽  
Anastasia Ustyugova ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Years ◽  
System Perspective ◽  
Diabetes Model ◽  
Life Years ◽  
Cost Effective Treatment ◽  
The Cost

Aim: The study assesses the cost–effectiveness of empagliflozin versus glimepiride in patients with Type 2 diabetes and uncontrolled by metformin alone in China, based on the EMPA-REG H2H-SU trial. Materials & methods: A calibrated version of the IQVIA Core Diabetes Model was used. Cost of complications and utility were taken from literature. The Chinese healthcare system perspective and 5% discounting rates were applied. Results: Empagliflozin+metformin provides additional quality-adjusted life-years (0.317) driven by a reduction in the number of cardiovascular and renal events, for an additional cost of $1382 (CNY9703) compared with glimepiride+metformin. Conclusion: Empagliflozin is cost-effective treatment versus glimepiride applying a threshold of $30,290 (CNY212,676).

scholarly journals Cost-Effectiveness of Dipeptidylpeptidase-4 Inhibitors Added to Metformin in Patients With Type 2 Diabetes in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Wen-Qiang Lin ◽  
Zhong-jie Cai ◽  
Tingting Chen ◽  
Mao-Bai Liu ◽  
Na Li ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Service Providers ◽  
Economic Outcomes ◽  
Medical Expenditure ◽  
Chinese Patients ◽  
Life Years ◽  
Probability Sensitivity Analysis ◽  
Dipeptidylpeptidase 4

PurposeDipeptidylpeptidase-4 (DPP-4) inhibitors, including linagliptin, alogliptin, saxagliptin, sitagliptin, and vildagliptin, are used for the treatment of type 2 diabetes mellitus (T2DM) patients in China. This study assessed the economic outcomes of different DPP-4 inhibitors in patients with T2DM inadequately controlled with metformin in the Chinese context.Materials and MethodsIn this study, the validated Chinese Outcomes Model for T2DM (COMT) was conducted to project economic outcomes from the perspective of Chinese healthcare service providers. Efficacy and safety, medical expenditure, and utility data were derived from the literature, which were assigned to model variables. The primary outputs of the model included the lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). One-way and probability sensitivity analysis was conducted to assess the potential uncertainties of parameters.ResultsOf the five competing strategies, alogliptin 25 mg strategy yielded the most significant health outcome, which associated with improvements in discounted QALY of 0.007, 0.014, 0.011, and 0.022 versus linagliptin 5 mg, saxagliptin 5 mg, sitagliptin 100 mg and vildagliptin50 mg, respectively. The sitagliptin 100 mg strategy was the cheapest option. The ICER of alogliptin 25 mg against sitagliptin 100 mg strategy was $6,952 per additional QALY gained, and the rest of the strategies were dominated or extended dominated. The most influential parameters were the cost of DPP-4 inhibitors and their treatment efficacy.ConclusionsThese results suggested that alogliptin was a preferred treatment option compared with other DPP-4 inhibitors for Chinese patients whose T2DM are inadequately controlled on metformin monotherapy.

Abstract P223: Cost-Effectiveness of Adding Aliskiren to Losartan and Optimal Antihypertensive Therapy in Patients with Hypertension, Type 2 Diabetes and Nephropathy with Residual Proteinuria

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Thomas E Delea ◽  
Charu Taneja ◽  
Aaron Moynahan ◽  
Helen Lau ◽  
Jean Lian ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cost Effectiveness ◽  
Antihypertensive Therapy ◽  
Regression Equations ◽  
Double Blind ◽  
System Perspective ◽  
Life Years ◽  
Lifetime Costs

Background: AVOID was a randomized, double-blind, 6-mo. trial of adding aliskiren to losartan and optimal antihypertensive therapy in patients with hypertension, type 2 diabetes, and nephropathy with residual proteinuria (urinary albumin creatinine ratio [UACR]>100mg/g) after ≥3 mo. of 100mg/d losartan. Aliskiren reduced mean UACR by 20% vs. placebo (P=.009). A previous study examined cost-effectiveness of aliskiren, but did not examine the potential effects of aliskiren on risks, costs, and quality of life effects of cardiovascular disease (CVD). Methods: A Markov model was used to project lifetime incidence of cardiovascular disease (CVD) and end-stage renal disease (ESRD), life years (LYs), quality-adjusted life years (QALYs), and expected lifetime costs (US healthcare system perspective) with losartan plus optimal antihypertensive therapy +/− aliskiren. Albuminuria progression by treatment was projected by generalized linear model regression equations fit to UACR from AVOID. Probabilities of CVD/ESRD by UACR and death without CVD/ESRD by age were obtained by calibrating the model to results for losartan and placebo in the RENAAL study. Other parameters were from published sources. Results: With losartan, mean UACR is projected to increase from approximately 790 mg/g at baseline to approximately 1700 mg/g at 3.5 years and to remain at this level for the duration of the model. Assuming the beneficial effects of aliskiren on the rate of progression of UACR persist for as long as patients remain on therapy, mean UACR with aliskiren plus losartan is projected to decline from 790 mg/g at baseline to 730 mg/g after 1 year, then increase to 740 mg/g after 4 years and remain at that level for the remainder of the model. Under these assumptions, adding aliskiren to losartan and optimal antihypertensive therapy is projected to reduce lifetime incidence of ESRD by 5% and CVD by 4%, increase LY by 0.19 and QALYs by 0.13. Expected lifetime costs are reduced by $7700, as savings from averted CVD ($1500) and ESRD ($12 800) more than offset additional costs associated with aliskiren treatment ($5400). Conclusion: Adding aliskiren to losartan in this setting leads to reduced cost and increased QALYs.

scholarly journals The cost–effectiveness of oral semaglutide versus empagliflozin in Type 2 diabetes in Denmark

2021 ◽  
Author(s):  
Lars H Ehlers ◽  
Mark Lamotte ◽  
Mafalda C Ramos ◽  
Susanne Sandgaard ◽  
Pia Holmgaard ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Duration Of Treatment ◽  
Diabetes Model ◽  
Life Years ◽  
The Cost

Aim: To evaluate the cost–effectiveness of oral semaglutide+metformin versus empagliflozin+metformin in people with Type 2 diabetes uncontrolled on msetformin alone. Materials and methods: The IQVIA Core Diabetes Model was populated with efficacy data from a head-to-head study between oral semaglutide+metformin and empagliflozin+metformin. Danish costs and quality-of-life data were sourced from literature. Price per day was Danish Krone (DKK) 25.53 for oral semaglutide and DKK11.40 for empagliflozin. Discounting was fixed at 4%. Scenario and sensitivity analyses were performed. Results: Over a lifetime, Core Diabetes Model projected 8.78 and 8.75 quality-adjusted life-years and a total cost of DKK 447,633 and DKK 387,786; thereby, generating an incremental cost–effectiveness ratio of DKK 1,930,548 for oral semaglutide+metformin versus empagliflozin+metformin. Scenario and sensitivity analyses showed the robustness of the outcomes. Duration of treatment with oral semaglutide is the key driver of the analyses. Conclusion: Oral semaglutide+metformin seems not cost-effective versus empagliflozin+metformin in patients uncontrolled on metformin in Denmark.

scholarly journals The Cost-Effectiveness of Empagliflozin Versus Liraglutide Treatment in People with Type 2 Diabetes and Established Cardiovascular Disease

2021 ◽  
Author(s):  
Lars Holger Ehlers ◽  
Mark Lamotte ◽  
Sofia Monteiro ◽  
Susanne Sandgaard ◽  
Pia Holmgaard ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cost Effectiveness ◽  
The Cost

scholarly journals Cost-effectiveness of empagliflozin in patients with type 2 diabetes and established cardiovascular disease in China

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Mafalda Ramos ◽  
Peng Men ◽  
Xu Wang ◽  
Anastasia Ustyugova ◽  
Mark Lamotte
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Incremental Cost ◽  
Treatment Effects ◽  
Specific Treatment ◽  
Treatment Comparison

Abstract Background In several cardiovascular outcome trials (CVOTs), empagliflozin (SGLT-2 inhibitor), sitagliptin (DPP-4 inhibitor) and liraglutide (GLP-1 receptor agonist) + standard of care (SoC) were compared to SoC in patients with type 2 diabetes and established cardiovascular disease (CVD). This study assessed the cost-effectiveness (CE) of empagliflozin + SoC in comparison to sitagliptin + SoC and liraglutide + SoC based on the respective CVOT. Methods The IQVIA Core Diabetes Model (CDM) was calibrated to reproduce the CVOT outcomes. EMPA-REG OUTCOME baseline characteristics and CVOT specific treatment effects on risk factors for cardiovascular disease (HbA1c, BMI, blood pressure, lipids) were applied. Three-year observed cardiovascular events of empagliflozin + SoC versus sitagliptin + SoC and liraglutide + SoC were derived from EMPA-REG OUTCOME and an indirect treatment comparison. Relative risk adjustments to calibrate the CDM were obtained after a trial and error process to match as closely the observed and CDM-predicted outcomes. The drug-specific treatment effects were considered up until HbA1c reached 8.5% and treatment switch occurred. After this switch, the United Kingdom Prospective Diabetes Study 82 risk equations predicted events based on co-existing risk factors and treatment intensification to basal bolus insulin were applied. The analysis was conducted from the perspective of the Chinese healthcare system applying 3% discounting. The time horizon was lifelong. Results Empagliflozin + SoC provides additional Quality Adjusted Life years (QALY + 0.564) for an incremental cost of 42,497RMB (US$6053) compared to sitagliptin + SoC, resulting in an Incremental Cost Utility Ratio of 75,349RMB (US$10,732), thus below the willingness-to-pay threshold of 212,676RMB, corresponding to three times the Gross Domestic Product in China (2019). Compared to liraglutide + SoC, empagliflozin + SoC use leads to 0.211QALY gained and cost savings of 71,427RMB (US$10,173) and is as such dominant. Scenario and probabilistic sensitivity analyses demonstrated the robustness of the results. Conclusion Results suggest that empagliflozin + SoC is cost-effective compared to sitagliptin + SoC and liraglutide + SoC at a willingness-to-pay threshold of 212,676RMB ($30,292)/QALY.

scholarly journals The cost-effectiveness of transcatheter aortic valve implantation: exploring the Italian National Health System perspective and different patient risk groups

2021 ◽  
Author(s):  
V. Lorenzoni ◽  
G. Barbieri ◽  
F. Saia ◽  
F. Meucci ◽  
G. L. Martinelli ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Aortic Valve ◽  
National Health System ◽  
Risk Groups ◽  
System Perspective ◽  
Transcatheter Aortic Valve ◽  
Life Years ◽  
Italian National Health ◽  
Valve Implantation ◽  
The Cost

Abstract Objectives To assess the cost-effectiveness (CE) of transcatheter aortic valve implantation (TAVI) in Italy, considering patient groups with different surgical risk. Methods A Markov model with a 1-month cycle length, comprising eight different health states, defined by the New York Heart Association functional classes (NYHA I–IV), with and without stroke plus death, was used to estimate the CE of TAVI for intermediate-, high-risk and inoperable patients considering surgical aortic valve replacement or medical treatment as comparators according to the patient group. The Italian National Health System perspective and 15-year time horizon were considered. In the base-case analysis, effectiveness data were retrieved from published efficacy data and total direct costs (euros) were estimated from national tariffs. A scenario analysis considering a micro-costing approach to estimate procedural costs was also considered. The incremental cost-effectiveness ratio (ICER) was expressed both in terms of costs per life years gained (LYG) and costs per quality adjusted life years (QALY). All outcomes and costs were discounted at 3% per annum. Univariate and probabilistic sensitivity analyses (PSA) were performed to assess robustness of results. Results Over a 15-year time horizon, the higher acquisition costs for TAVI were partially offset in all risk groups because of its effectiveness and safety profile. ICERs were €8338/QALY, €11,209/QALY and €10,133/QALY, respectively, for intermediate-, high-risk and inoperable patients. ICER values were slightly higher in the scenario analysis. PSA suggested consistency of results. Conclusions TAVI would be considered cost-effective at frequently cited willingness-to-pay thresholds; further studies could clarify the CE of TAVI in real-life scenarios.

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