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Cost-Effectiveness of Dapagliflozin as Add-On to Metformin for the Treatment of Type 2 Diabetes Mellitus in Greece.
- Source :
-
Clinical drug investigation [Clin Drug Investig] 2016 Aug; Vol. 36 (8), pp. 649-59. - Publication Year :
- 2016
-
Abstract
- Background and Objective: Type 2 diabetes mellitus (T2DM) is a chronic progressive disease that has been spread worldwide over the past three decades and associated with increased morbidity and mortality resulting in considerable socioeconomic implications for national healthcare systems. Effective management of disease is highly needed ensuring patients receive the best possible care within the available budget. The objective of this study was to evaluate the long-term cost-effectiveness of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT-2) inhibitor, compared with a sulfonylurea (SU) or a dipeptidyl-peptidase-4 inhibitor (DPP-4i), when added to metformin, in T2DM patients inadequately controlled on metformin alone in Greece.<br />Methods: The published and validated Cardiff diabetes model, a lifetime micro-simulation model, was adapted to a Greek healthcare setting to determine the incidence of micro- and macro-vascular complications and diabetes-specific and all-cause mortality. Clinical, cost, and utility data were retrieved from literature and assigned to model parameters to calculate total quality-adjusted life-years (QALYs) and total costs as well as incremental cost-effectiveness ratios (ICERs). The analysis was conducted from the perspective of a third-party payer in Greece. Uncertainty surrounding important model parameters was explored with univariate and probabilistic sensitivity analyses (PSA).<br />Results: Over a patient's lifetime, dapagliflozin was associated with 0.48 and 0.04 incremental QALYs compared with SU and DPP-4i, respectively, at additional costs of €5142 and €756, respectively. The corresponding ICERs were €10,623 and €17,695 per QALY gained versus the treatment with SU and DPP-4i, respectively. Results were robust across various univariate and scenario analyses. At the defined willingness-to-pay threshold of €34,000 per QALY gained, PSA estimated that treatment with dapagliflozin had a 100 % and 79.7 % probability of being cost-effective relative to the SU and DPP-4i treatments.<br />Conclusions: Dapagliflozin in combination with metformin was shown to be a cost-effective treatment alternative for patients with T2DM whose metformin regimen does not provide sufficient glycemic control in a Greek healthcare setting.
- Subjects :
- Aged
Benzhydryl Compounds adverse effects
Cost-Benefit Analysis
Diabetes Mellitus, Type 2 complications
Dipeptidyl-Peptidase IV Inhibitors economics
Dipeptidyl-Peptidase IV Inhibitors therapeutic use
Drug Therapy, Combination economics
Female
Glucosides adverse effects
Greece
Humans
Hypoglycemic Agents adverse effects
Male
Metformin adverse effects
Middle Aged
Models, Economic
Quality-Adjusted Life Years
Sodium-Glucose Transporter 2
Sodium-Glucose Transporter 2 Inhibitors
Treatment Outcome
Benzhydryl Compounds economics
Benzhydryl Compounds therapeutic use
Diabetes Mellitus, Type 2 drug therapy
Diabetes Mellitus, Type 2 economics
Glucosides economics
Glucosides therapeutic use
Hypoglycemic Agents economics
Hypoglycemic Agents therapeutic use
Metformin economics
Metformin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1179-1918
- Volume :
- 36
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Clinical drug investigation
- Publication Type :
- Academic Journal
- Accession number :
- 27221806
- Full Text :
- https://doi.org/10.1007/s40261-016-0410-2