Comparison of costs and outcomes of dapagliflozin with other glucose-lowering therapy classes added to metformin using a short-term cost-effectiveness model in the US setting
| Autor: | Kelly F Bell, Praveen Dhankhar, Abhiroop Chakravarty, Mohini Rastogi |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
United Nations Cost effectiveness Cost-Benefit Analysis Blood Pressure 030209 endocrinology & metabolism Type 2 diabetes 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Glucosides medicine Humans Hypoglycemic Agents 030212 general & internal medicine Benzhydryl Compounds Dapagliflozin Intensive care medicine Glycated Hemoglobin Glucose lowering Dipeptidyl-Peptidase IV Inhibitors Cost–benefit analysis business.industry Health Policy Body Weight medicine.disease Economic benefits Hypoglycemia Metformin United States Term (time) Sulfonylurea Compounds Diabetes Mellitus Type 2 chemistry Health Resources Drug Therapy Combination Thiazolidinediones Quality-Adjusted Life Years Health Expenditures business medicine.drug |
| Zdroj: | Journal of Medical Economics. 21:497-509 |
| ISSN: | 1941-837X 1369-6998 |
| Popis: | To compare 1-year costs and benefits of dapagliflozin (DAPA), a sodium-glucose cotransporter-2 (SGLT-2) inhibitor, with those of other treatments for type 2 diabetes (T2D), such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), sulfonylureas (SUs), thiazolidinediones (TZDs), and dipeptidyl peptidase-4 inhibitors (DPP-4i), all combined with metformin.A short-term decision-analytic model with a 1-year time horizon was developed from a payer's perspective in the United States setting. Costs and benefits associated with four clinical end-points (glycated hemoglobin [A1C], body weight, systolic blood pressure [SBP], and risk of hypoglycemia) were evaluated in the analysis. The impact of DAPA and other glucose-lowering therapy classes on these clinical end-points was estimated from a network meta-analysis (NMA). Data for costs and quality-adjusted life-years (QALYs) associated with a per-unit change in these clinical end-points were taken from published literature. Drug prices were taken from an annual wholesale price list. All costs were inflation-adjusted to December 2016 costs using the medical care component of the consumer price index. Total costs (both medical and drug costs), total QALYs, and incremental cost-effectiveness ratios (ICERs) were estimated. Sensitivity analyses (SA) were performed to explore uncertainty in the inputs. To assess face validity, results from the short-term model were compared with long-term models published for these drugs.The total annual medical cost for DAPA was less than that for GLP-1RA ($186 less), DPP-4i ($1,142 less), SU ($2,474 less), and TZD ($1,640 less). Treatment with DAPA resulted in an average QALY gain of 0.0107, 0.0587, 0.1137, and 0.0715 per treated patient when compared with GLP-1RA, DPP-4i, SU, and TZD, respectively. ICERs for DAPA vs SU and TZD were $19,005 and $25,835, respectively. DAPA was a cost-saving option when compared with GLP-1RAs and DPP-4is. Among all four clinical end-points, change in weight had the greatest impact on total annual costs and ICERS. Sensitivity analysis showed that results were robust, and results from the short-term model were found to be similar to those of published long-term models.This analysis showed that DAPA was cost-saving compared with GLP-1RA and DPP-4i, and cost-effective compared with SU and TZD in the US setting over 1 year. Furthermore, the results suggest that, among the four composite clinical end-points, change in weight and SBP had an impact on cost-effectiveness results. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|