1. A cost-controlling treatment strategy of adding liraglutide to insulin in type 2 diabetes.
- Author
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de Wit HM, Vervoort GMM, de Galan BE, and Tack CJ
- Subjects
- Aged, Blood Glucose analysis, Diabetes Mellitus, Type 2 blood, Diabetes Mellitus, Type 2 drug therapy, Drug Therapy, Combination economics, Female, Glycated Hemoglobin analysis, Humans, Hypoglycemic Agents administration & dosage, Insulin administration & dosage, Liraglutide administration & dosage, Male, Middle Aged, Treatment Outcome, Weight Loss drug effects, Diabetes Mellitus, Type 2 economics, Health Care Costs, Hypoglycemic Agents economics, Insulin economics, Liraglutide economics
- Abstract
Background: Addition of the GLP-1 receptor agonist liraglutide to insulin can reverse insulin-associated weight gain, improve HbA1c and decrease the need for insulin, but is expensive. From a cost perspective, such treatment should be discontinued when it is clear that treatment targets will not be achieved. Our aim was to find the best cost-controlling treatment strategy: the shortest possible trial period needed to discriminate successfully treated patients from those failing to achieve predefined targets of treatment success., Methods: We used data from the 'Effect of Liraglutide on insulin-associated wEight GAiN in patients with Type 2 diabetes' (ELEGANT) trial, comparing additional liraglutide (n = 47) and standard insulin therapy (n = 24) during 26 weeks, to calculate the costs associated with different trial periods. Treatment success after 26 weeks was defined by having achieved ≥ 2 of the following: ≥ 4% weight loss, HbA1c ≤ 53 mmol/mol (7%), and/or discontinuation of insulin., Results: The additional direct costs of adding liraglutide for 26 weeks were € 699 per patient, or € 137 per 1 kg weight loss, compared with standard therapy. The best cost-controlling treatment strategy (identifying 21 of 23 responders, treating four non-responders) was to continue treatment in patients showing ≥ 3% weight loss or ≥ 60% decrease in insulin dose at 8 weeks, with a total cost of € 246 for this t rial period, saving € 453 in case of early discontinuation., Conclusion: An 8-week trial period of adding liraglutide to insulin in patients with insulin-associated weight gain is an effective cost-controlling treatment strategy if the liraglutide is discontinued in patients not showing an early response regarding weight loss or insulin reduction.
- Published
- 2017