Cost-effectiveness of GLP-1 receptor agonists versus insulin for the treatment of type 2 diabetes: a real-world study and systematic review

Abstract Background To conduct a real-word-study-based cost-effectiveness analysis of a GLP-1 receptor agonist (GLP-1RA) versus insulin among type 2 diabetes patients requiring intensified injection therapy and a systematic review of cost-effectiveness studies of GLP-1RAs versus insulin. Methods Individual-level analyses incorporating real-world effectiveness and cost data were conducted for a cohort of 1022 propensity-score-matched pairs of GLP-1RA and insulin users from Taiwan’s National Health Insurance Research Database, 2007–2016. Study outcomes included the number needed to treat (NNT) to prevent one case of clinical events, healthcare costs, and cost per case of event prevented. Costs were in 2019 US dollars. Analyses were performed from a third-party payer and healthcare sector perspectives. Structured systematic review procedures were conducted to synthesize updated evidence on the cost-effectiveness of GLP-1RAs versus insulin. Results Over a mean follow-up of 2.3 years, the NNT using a GLP-1RA versus insulin to prevent one case of all-cause mortality and hospitalized hypoglycemia was 57 and 30, respectively. Using GLP-1RAs instead of insulin cost US$54,851 and US$29,115 per case of all-cause mortality and hospitalized hypoglycemia prevented, respectively, from the payer perspective, and saved US$19,391 and US$10,293, respectively, from the healthcare sector perspective. Sensitivity analyses showed that the probability of using GLP-1RAs versus insulin being cost-effective for preventing one case of all-cause mortality or hospitalized hypoglycemia ranged from 60 to 100%. The systematic review revealed a cost-effective profile of using GLP-1RAs versus insulin. Conclusions Using GLP-1RAs versus insulin for type 2 diabetes patients requiring intensified injection therapy in clinical practice is cost-effective.

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Cost-Effectiveness of SGLT2is Versus DPP4is Among Type 2 Diabetes Patients with and Without Established Cardiovascular Disease: A Model-Based Simulation Analysis Using 10-Year Real-World Data and Systematic Review

10.21203/rs.3.rs-1126975/v1 ◽

2021 ◽

Author(s):

Zi-Yang Peng ◽

Chun-Ting Yang ◽

Huang-Tz Ou ◽

Shihchen Kuo

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Cost Effectiveness ◽

Cost Saving ◽

Real World ◽

Cost Effective ◽

Real World Data ◽

World Data

Abstract Background: We conducted a model-based economic analysis of sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus dipeptidyl peptidase-4 inhibitors (DPP4is) in type 2 diabetes (T2D) patients with and without established cardiovascular disease (CVD) using 10-year real-world data. Methods: A Markov model was utilized to estimate healthcare costs and quality-adjusted life-years (QALYs) over a 10-year simulation time horizon from a healthcare sector perspective, with both costs and QALYs discounted at 3% annually. Model inputs were derived from analyses of Taiwan’s National Health Insurance Research Database or published studies of Taiwanese populations. The primary outcome measure was the incremental cost-effectiveness ratios (ICERs). Incorporated with our study findings, a structured systematic review was conducted to synthesize updated evidence on the cost-effectiveness of SGLT2is versus DPP4is. Results: Over 10 years, use of SGLT2is versus DPP4is yielded ICERs of $3,244 and $4,186 per QALY gained for T2D patients with and without established CVD, respectively. Results were robust across a series of sensitivity and scenario analyses, showing ICERs between $-1,074 (cost-saving) and $8,467 per QALY gained for T2D patients with established CVD and between $369 and $37,122 per QALY gained for T2D patients without established CVD. A systematic review revealed a cost-effective or even cost-saving profile of using SGLT2is for T2D treatment. Conclusions: Use of SGLT2is versus DPP4is was highly cost-effective for T2D patients regardless of patients’ CVD history in real-world clinical practice. Our results extend current evidence by demonstrating SGLT2is as an economically rational alternative over DPP4is for T2D treatment in routine care. Future research is warranted to explore heterogenous economic benefits of SGLT2is given diverse patient characteristics in clinical settings.

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Cost-effectiveness of Community-Based Depression Interventions for Rural and Urban Adults With Type 2 Diabetes: Projections From Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II

10.2337/figshare.13622906.v1 ◽

2021 ◽

Author(s):

Shihchen Kuo ◽

Wen Ye ◽

Mary de Groot ◽

Chandan Saha ◽

Jay H. Shubrook ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Cost Saving ◽

Behavioral Therapy ◽

Intervention Strategy ◽

Cost Effective ◽

Sensitivity Analyses ◽

Healthcare Sector ◽

Community Based

Objective: We estimated the cost-effectiveness of the Program ACTIVE II community-based exercise (EXER), cognitive behavioral therapy (CBT), and EXER+CBT interventions in adults with type 2 diabetes and depression relative to UC and each other. Research Design and Methods: Data were integrated into the Michigan Model for Diabetes to estimate cost and health outcomes over a 10-year simulation time horizon from the healthcare sector and societal perspectives, discounting costs and benefits at 3% annually. Primary outcome was cost per quality-adjusted life-year (QALY) gained. Results: From the healthcare sector perspective, the EXER intervention strategy saved $313 per patient and produced 0.38 more QALY (cost-saving), the CBT intervention strategy cost $596 more and gained 0.29 more QALY ($2,058/QALY), and the EXER+CBT intervention strategy cost $403 more and gained 0.69 more QALY ($585/QALY) compared to UC. Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention strategy cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared to UC, the EXER intervention strategy saved $126 (cost-saving), the CBT intervention strategy cost $2,838/QALY, and the EXER+CBT intervention strategy cost $1,167/QALY. Both EXER and EXER+CBT interventions still dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention strategy cost $3,021/QALY. Results were robust in sensitivity analyses. Conclusions: All three Program ACTIVE II interventions represented a good value for money compared to UC. The EXER+CBT intervention was highly cost-effective or cost-saving compared to the CBT or EXER interventions.

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Cost-effectiveness of Community-Based Depression Interventions for Rural and Urban Adults With Type 2 Diabetes: Projections From Program ACTIVE (Adults Coming Together to Increase Vital Exercise) II

10.2337/figshare.13622906 ◽

2021 ◽

Author(s):

Shihchen Kuo ◽

Wen Ye ◽

Mary de Groot ◽

Chandan Saha ◽

Jay H. Shubrook ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Cost Saving ◽

Behavioral Therapy ◽

Intervention Strategy ◽

Cost Effective ◽

Sensitivity Analyses ◽

Healthcare Sector ◽

Community Based

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Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis

Endocrine ◽

10.1007/s12020-016-1168-2 ◽

2016 ◽

Vol 55 (3) ◽

pp. 712-731 ◽

Cited By ~ 66

Author(s):

Xiaoqin He ◽

Jie Li ◽

Bin Wang ◽

Qiuming Yao ◽

Ling Li ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Management Education ◽

Meta Analysis ◽

Self Management ◽

All Cause Mortality ◽

Diabetes Patients

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Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes

BMJ Open ◽

10.1136/bmjopen-2017-017184 ◽

2017 ◽

Vol 7 (11) ◽

pp. e017184 ◽

Cited By ~ 28

Author(s):

Samantha Roberts ◽

Eleanor Barry ◽

Dawn Craig ◽

Mara Airoldi ◽

Gwyn Bevan ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Cost Effectiveness ◽

High Risk ◽

Cost Effective ◽

Economic Evaluations ◽

Lifestyle Interventions ◽

Prevention Programmes ◽

Incident Cases

ObjectiveExplore the cost-effectiveness of lifestyle interventions and metformin in reducing subsequent incidence of type 2 diabetes, both alone and in combination with a screening programme to identify high-risk individuals.DesignSystematic review of economic evaluations.Data sources and eligibility criteriaDatabase searches (Embase, Medline, PreMedline, NHS EED) and citation tracking identified economic evaluations of lifestyle interventions or metformin alone or in combination with screening programmes in people at high risk of developing diabetes. The International Society for Pharmaco-economics and Outcomes Research’s Questionnaire to Assess Relevance and Credibility of Modelling Studies for Informing Healthcare Decision Making was used to assess study quality.Results27 studies were included; all had evaluated lifestyle interventions and 12 also evaluated metformin. Primary studies exhibited considerable heterogeneity in definitions of pre-diabetes and intensity and duration of lifestyle programmes. Lifestyle programmes and metformin appeared to be cost effective in preventing diabetes in high-risk individuals (median incremental cost-effectiveness ratios of £7490/quality-adjusted life-year (QALY) and £8428/QALY, respectively) but economic estimates varied widely between studies. Intervention-only programmes were in general more cost effective than programmes that also included a screening component. The longer the period evaluated, the more cost-effective interventions appeared. In the few studies that evaluated other economic considerations, budget impact of prevention programmes was moderate (0.13%–0.2% of total healthcare budget), financial payoffs were delayed (by 9–14 years) and impact on incident cases of diabetes was limited (0.1%–1.6% reduction). There was insufficient evidence to answer the question of (1) whether lifestyle programmes are more cost effective than metformin or (2) whether low-intensity lifestyle interventions are more cost effective than the more intensive lifestyle programmes that were tested in trials.ConclusionsThe economics of preventing diabetes are complex. There is some evidence that diabetes prevention programmes are cost effective, but the evidence base to date provides few clear answers regarding design of prevention programmes because of differences in denominator populations, definitions, interventions and modelling assumptions.

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Within trial cost-effectiveness of a structured lifestyle intervention in adults with overweight/obesity and type 2 diabetes: Results from the Action for Health in Diabetes (Look AHEAD) Study

10.2337/figshare.13084802 ◽

2020 ◽

Author(s):

Ping Zhang ◽

Karen M. Atkinson ◽

George Bray ◽

Haiying Chen ◽

Jeanne M. Clark ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Lifestyle Intervention ◽

Health Utility Index ◽

Health Benefit ◽

Cost Effective ◽

Health Utility ◽

Health Care Expenditures ◽

Quality Adjusted Life Year

OBJECTIVE To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared to standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. RESEARCH DESIGN AND METHODS Data were from 4,827 participants during the first 9 years of the study from 2001 to 2012. Information on Health Utility Index-2 and -3, SF-6D, and Feeling Thermometer [FT]), cost of delivering the interventions, and health expenditures were collected during the study. CE was measured by incremental cost-effectiveness ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 US dollars. RESULTS <a>Over the </a>9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.17 and 0.16, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs, to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. Conclusions Whether ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions.

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