Cost Effectiveness of Saxagliptin and Metformin versus Sulfonylurea and Metformin in the Treatment of Type 2 Diabetes Mellitus in Germany View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2012-03

AUTHORS

Wilma Erhardt, Klas Bergenheim, Isabelle Duprat-Lomon, Phil McEwan

ABSTRACT

Background: The lack of adequate glycaemic control for patients with type 2 diabetes mellitus (T2DM), especially with existing second-line therapies, represents an unmet medical need. Of the newer therapies, the incretin-based medicines, such as saxagliptin, look promising to consolidate second-line pharmacotherapy.Objective: This study evaluates the long-term economic consequences of saxagliptin versus sulfonylurea (glipizide) as second-line therapy when used in combination with metformin after failure of monotherapy treatment with metformin, in patients with T2DM in Germany.Methods: A published discrete event simulation model with a fixed-time increment was used to model the effects of different treatment scenarios over a 40-year (life-) time horizon. Disease progression was modelled using evidence from the United Kingdom Prospective Diabetes Study (UKPDS) 68. The treatment sequence matched that of published German guidelines, and efficacy and safety data were derived from published sources. The model assumes that quality-adjusted life-years (QALYs) are affected by complications, hypoglycaemic events and weight change over a lifetime. Costs were specific to the German setting, where sulfonylureas are generic. Costs and effects were discounted annually at 3%. The extended perspective of the national sick funds was adopted, and recommendations from the Institute for Quality and Efficiency in Health Care (IQWiG) were considered.Results: In the base-case analysis, treatment with saxagliptin plus metformin was associated with a lower incidence of both symptomatic and severe hypoglycaemic events, resulting in an incremental benefit of 0.12 QALYs and an incremental cost-effectiveness ratio (ICER) of €13 931 per QALY gained compared with sulfonylurea plus metformin (year of costing 2009). Modest reductions in all macro- and microvascular complications were seen in those receiving saxagliptin plus metformin compared with sulfonylurea plus metformin. Sensitivity analysis showed that treatment-related weight changes, as a risk factor for complications, represent the most influential driver of cost effectiveness.Conclusion: The study demonstrated improved outcomes with saxagliptin at a cost that would likely be considered acceptable in the German setting. Furthermore, the findings of the sensitivity analysis suggest that the results are robust to various assumptions concerning input variables and modelling assumptions. More... »

PAGES

189-202

References to SciGraph publications

  • 2008-06-23. Evaluating the cost-effectiveness of therapy conversion to insulin detemir in patients with type 2 diabetes in Germany: a modelling study of long-term clinical and cost outcomes in ADVANCES IN THERAPY
  • 2009-10. Saxagliptin in DRUGS
  • 2006-06-27. Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy in DIABETOLOGIA
  • 2009-03-27. Saxagliptin: a new DPP-4 inhibitor for the treatment of type 2 diabetes mellitus in ADVANCES IN THERAPY
  • 2006-11. Cost-effectiveness of Rosiglitazone Oral Combination for the Treatment of Type 2 Diabetes in Germany in PHARMACOECONOMICS
  • 2004-04. Cost Effectiveness of Combination Therapy with Pioglitazone for Type 2 Diabetes Mellitus from a German Statutory Healthcare Perspective in PHARMACOECONOMICS
  • 2010-08. Assessing the Relationship between Computational Speed and Precision in PHARMACOECONOMICS
  • 2004-10-27. A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68) in DIABETOLOGIA
  • 2009-05-05. Cost-effectiveness of pioglitazone in type 2 diabetes patients with a history of macrovascular disease: a German perspective in COST EFFECTIVENESS AND RESOURCE ALLOCATION
  • 2005-06-17. Cost of atherothrombotic diseases—myocardial infarction, ischaemic stroke and peripheral arterial occlusive disease—in Germany in JOURNAL OF PUBLIC HEALTH
  • 2008-06-06. Langzeitkrankheitskosten 4 Jahre nach Schlaganfall oder TIA in Deutschland in DER NERVENARZT
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    http://scigraph.springernature.com/pub.10.2165/11597060-000000000-00000

    DOI

    http://dx.doi.org/10.2165/11597060-000000000-00000

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1033801058

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/22292415


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