BackgroundType 2 diabetes mellitus (T2DM) is a chronic, progressive condition where the primary treatment goal is to maintain control of glycated haemoglobin (HbA1c). In order for healthcare decision makers to ensure patients receive the highest standard of care within the available budget, the clinical benefits of each treatment option must be balanced against the economic consequences.The aim of this study was to assess the cost-effectiveness of dapagliflozin, the first-in-class sodium-glucose co-transporter 2 (SGLT2) inhibitor, compared with a dipeptidyl peptidase-4 inhibitor (DPP-4i), when added to metformin for the treatment of patients with T2DM inadequately controlled on metformin alone.MethodsThe previously published and validated Cardiff diabetes model was used as the basis for this economic evaluation, with treatment effect parameters sourced from a systematic review and network meta-analysis. Costs, derived from a UK healthcare system perspective, and quality-adjusted life years (QALYs), were used to present the final outcome as an incremental cost-effectiveness ratio (ICER) over a lifetime horizon. Univariate and probabilistic sensitivity analyses (PSA) were carried out to assess uncertainty in the model results.ResultsCompared with DPP-4i, dapagliflozin was associated with a mean incremental benefit of 0.032 QALYs (95 % confidence interval [CI]: −0.022, 0.140) and with an incremental cost of £216 (95 % CI: £-258, £795). This resulted in an ICER point estimate of £6,761 per QALY gained. Sensitivity analysis determined incremental costs to be insensitive to variation in most parameters, with only the treatment effect on weight having a notable impact on the incremental QALYs; however, there were no scenarios which raised the ICER above £15,000 per QALY. The PSA estimated that dapagliflozin had an 85 % probability of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY gained.ConclusionsDapagliflozin in combination with metformin was shown to be a cost-effective treatment option from a UK healthcare system perspective for patients with T2DM who are inadequately controlled on metformin alone.
Dapagliflozin in combination with metformin was shown to be a cost-effective treatment option compared with sulfonylurea from a UK healthcare perspective for people with Type 2 diabetes mellitus who are inadequately controlled on metformin monotherapy.
IntroductionWe sought to examine patients’ perceptions of disease burden and treatment impact, and what patients value over the course of the asthma experience.MethodsPatient focus groups were conducted in three countries, the USA (n = 8 patients), the United Kingdom (n = 7 patients), and Germany (n = 7 patients), to examine aspects of disease burden and patient experience (physical, emotional, clinical, economic, and social). Cause and effect were also explored. Global Initiative for Asthma guidelines were used to screen patients by severity, based on age, sex, time since diagnosis, number of attacks, oral corticosteroid use, and number of therapies needed to control symptoms. Patients classified and ranked aspects of disease burden, including whether it was continuous or episodic in nature, and discussed the interventions used to manage their asthma.ResultsThe overall burden of illness was driven by the combined effect of the disease and treatment burdens. All patients highlighted the negative impact of oral corticosteroids. Patients believed that they were the key actors in their asthma management (not healthcare professionals), and reported the physical and emotional burdens as being the most dominant. Understanding of the terms “attack” or “exacerbation” differed significantly between patients, and did not necessarily match the clinical definitions. Patients considered asthma to be an individualized condition that drives lifestyle changes; disease management drives burden and vice versa. Patients perceived that burden was continuous over time, with specific phases of variable duration—before, during, and after an attack—whereas other stakeholders had a more episodic focus. Patients expected more holistic and personalized approaches for managing their asthma.ConclusionsThe research indicated a misalignment between what patients value and what clinicians, payers, and regulators consider in their assessments and decisions. Greater alignment among the different stakeholders, and more inclusion of patients’ values in decision making, will improve outcomes.
Objectives: With new classes of T2DM medications offering weight reduction in addition to better glycaemic control, HTA agencies expect fuller accounting of the impact of post-trial weight trajectory assumptions on cost-effectiveness. Four alternative scenarios were examined using the example of the novel SGLT-2 inhibitor canagliflozin (CANA) in the UK treatment setting. MethOds: The importance of alternative assumptions was illustrated using CANA 300mg versus glimepiride (GLIM; 1mg titrated to 6mg or 8mg) in dual therapy with metformin simulated over 40 years using the ECHO-T2DM model loaded with patient characteristics, treatment effects, and adverse event rates from the DIA3009 trial, in which CANA 300mg reduced body weight by-5.7% versus GLIM over 52 weeks. HbA1c was assumed to drift annually by 0.14% for CANA (similar to metformin in ADOPT), 0.24% for GLIM (as sulphonylurea in ADOPT), and 0.15% for rescue therapy with insulin (initiated when HbA1c > 7.5%). Upon treatment discontinuation, four alternative weight-trajectory assumptions were applied: (A) weight change maintained permanently; (B) CANA weight reduction disappears fully at treatment discontinuation, GLIM weight-gain permanent; (C) GLIM weight-gain permanent, forced convergence of weight upon CANA discontinuation; (D) weight changes disappear fully at discontinuation for both treatments. A weight increase was applied when insulin was initiated and proportional weight changes were applied when insulin dose was titrated upwards. Results: CANA 300mg generated more QALYs at modest incremental cost, resulting in ICERs of £2,766 to £4,317 in the scenarios. Maintaining the benefits permanently (A) generated the largest QALY gain (0.243); complete elimination of benefits at discontinuation (D) offered the smallest (0.198). The proportions of incremental QALYs attributable to weight differences were 34.4%, 19.5%, 18.9% and 17.4% for Scenarios A to D, respectively. cOnclusiOns: CANA 300mg was cost-effective in each of four weight scenarios following discontinuation. Further work is required to define the most clinically plausible scenarios. PDB54 The CosT-effeCTiveness of DaPagliflozin (forxiga®) versus a DPP-4 inhiBiTor in The TreaTmenT of TyPe 2 DiaBeTes melliTus (T2Dm) in englanD anD Wales
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.