A budget impact analysis of substituting sitagliptin with liraglutide in type 2 diabetes from a private health insurance perspective in Egypt

Abstract Introduction Type 2 diabetes mellitus causes a sizable burden globally from both health and economic points of view. This study aimed to assess the budget impact of substituting sitagliptin with liraglutide versus other glucose-lowering drugs from the private health insurance perspective in Egypt over a 3-year time horizon. Methods Two budget impact models were compared with the standard of care (metformin, pioglitazone, gliclazide, insulin glargine, repaglinide, and empagliflozin) administered in addition to liraglutide or sitagliptin versus the standard of care with placebo. A gradual market introduction of liraglutide or sitagliptin was assumed, and the existing market shares for the other glucose-lowering drugs were provided and validated by the Expert Panel. The event rates were extracted from the LEADER and TECOS trials. Direct and mortality costs were measured. Sensitivity analyses were performed. Results The estimated target population of 120,574 type 2 diabetic adult patients was associated with cardio vascular risk. The budget impact per patient per month for liraglutide is EGP29 ($6.7), EGP39 ($9), and EGP49 ($11.3) in the 1st, 2nd, and 3rd years, respectively. The budget impact per patient per month for sitagliptin is EGP11 ($2.5), EGP14 ($3.2), and EGP18 ($4.1) in the 1st, 2nd, and 3rd years, respectively. Furthermore, adoption of liraglutide resulted in 203 fewer deaths and 550 avoided hospitalizations, while sitagliptin resulted in 43 increased deaths and 14 avoided hospitalizations. The treatment costs of liraglutide use are mostly offset by substantial savings due to fewer cardiovascular-related events, avoided mortality and avoided hospitalizations over 3 years. Conclusion Adding liraglutide resulted in a modest budget impact, suggesting that the upfront drug costs were offset by budget savings due to fewer cardiovascular-related complications and deaths avoided compared to the standard of care. Sitagliptin resulted in a small budget impact but was associated with increased deaths and fewer hospitalizations avoided.

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A Budget Impact Analysis of Substituting Sitagliptin with Liraglutide in Type 2 Diabetes from A Private Health Insurance Perspective in Egypt

10.21203/rs.3.rs-772763/v1 ◽

2021 ◽

Author(s):

Gihan Hamdy El-sisi ◽

Ayman Afify ◽

Ashraf Abgad ◽

Ibtissam Zakaria ◽

Nabil Nasif ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Insurance ◽

Private Health Insurance ◽

Impact Analysis ◽

Budget Impact ◽

Standard Of Care ◽

Sensitivity Analyses ◽

Glucose Lowering ◽

Insurance Perspective

Abstract IntroductionType 2 diabetes mellitus (T2DM) causes a sizable burden globally both from health and economic points of view.This study aimed to assess the budget impact of substituting sitagliptin with liraglutide versus other glucose lowering drugs from the private health insurance perspective in Egypt over a 3-year time horizon. MethodsTwo budget impact models were comparedthe standard of care (metformin, pioglitazone, gliclazide, insulin glargine, repaglinide, and empagliflozin)administered in addition to liraglutide or sitagliptin versus the standard of care with placebo. A gradual market introduction of liraglutide or sitagliptin was assumed, and the existing market shares for the other glucose lowering drugs were provided and validated by Expert Panel. The event rates were extracted from the LEADER and TECOS trials. Direct and mortality costs were measured. Sensitivity analyses were performed. ResultsThe estimated target population of 120,574 T2DM adult patients were associated with CV risk. The budget impact per patient per month (PPPM) for liraglutide is EGP29 ($6.7), EGP39 ($9), and EGP49 ($11.3) in the first, second, and third year, respectively. The budget impact PPPM for sitagliptin is EGP11 ($2.5), EGP14 ($3.2), and EGP18 ($4.1) in the first, second, and third year, respectively. Furthermore, adoption of liraglutide resulted in 203 fewer deaths and 550 avoided hospitalizations, while sitagliptin resulted in 43 increased deaths and 14 avoided hospitalizations. The treatment costs of liraglutide use are mostly offset by substantial savings due to fewer CV-related events, avoided mortality and avoided hospitalizations over 3-years. Conclusion Adding liraglutide resulted in a modest budget impact, suggesting that the upfront drug costs were offset by budget savings due to fewer CV-related complications and deaths avoided compared to the standard of care. While sitagliptin resulted in a small budget impact but associated with deaths increased and less hospitalizations avoided.

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