Cost-effectiveness analysis of metformin+dipeptidyl peptidase-4 inhibitors compared to metformin+sulfonylureas for treatment of type 2 diabetes

Kwon, Christina Soeun; Seoane‐Vazquez, Enrique; Rodríguez-Monguió, Rosa

doi:10.1186/s12913-018-2860-0

Cited by 28 publications

(34 citation statements)

References 31 publications

(43 reference statements)

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“…As RCTs are pre‐designed, the participants enrolled are followed up during a short‐term period, and medication costs are generally covered by research funding; thus, costs are rarely evaluated in RCTs. It is noteworthy that several retrospective studies, based on data from the literature search or on hospital surveys from different countries, demonstrate that metformin+DPP‐4i treatment is cost‐effective compared to metformin+SU treatment as long‐term dual therapy in T2D, including the costs associated with hypoglycaemia, weight gain and complications . We tried to calculate medication expenditure according to patient compliance in our study.…”

Section: Discussionmentioning

confidence: 99%

“…As RCTs are pre-designed, the participants enrolled are followed up during a short-term period, and medication costs are generally It is noteworthy that several retrospective studies, based on data from the literature search or on hospital surveys from different countries, demonstrate that metformin+DPP-4i treatment is cost-effective compared to metformin+SU treatment as long-term dual therapy in T2D, including the costs associated with hypoglycaemia, weight gain and complications. [28][29][30][31] We tried to calculate medication expenditure according to patient compliance in our study. Total drug expenditure over 48 weeks of treatment in the saxagliptin (Onglyza) group (¥2824) was 1.6-fold that in the glimepiride (Amaryl) group (¥1772), with comparable improvement in glycaemic control.…”

Section: Discussionmentioning

confidence: 99%

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Comparative effect of saxagliptin and glimepiride with a composite endpoint of adequate glycaemic control without hypoglycaemia and without weight gain in patients uncontrolled with metformin therapy: Results from the SPECIFY study, a 48‐week, multi‐centre, randomized, controlled trial

Zhang

et al. 2019

Diabetes Obesity Metabolism

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Aims: To compare the efficacy and safety of saxagliptin and glimepiride in type 2 diabetes (T2D) patients who are inadequately controlled with metformin monotherapy. Materials and methods:In this 48-week, multi-centre, open-label, randomized, parallel trial (NCT02280486, clinicaltrials.gov), a total of 388 T2D patients were randomized 1:1 to saxagliptin or glimepiride groups. The primary endpoint was achievement of HbA1c <7.0%, without hypoglycaemia, defined as blood glucose <3.9 mmol/L and weight gain <3.0% after 48 weeks of treatment.Results: Over 48 weeks, a greater proportion of patients achieved the primary endpoint with saxagliptin compared with glimepiride (43.3% vs 31.3%; odds ratio, 1.38, 95% CI, 1.05-1.82; P = 0.019), especially among patients with baseline HbA1c <8.0%, duration <5 years or baseline BMI ≥25 kg/m 2 . Mean reduction in HbA1c was similar in the two treatment groups at Week 48 (−0.94% with saxagliptin vs −0.98% with glimepiride; P = 0.439). Bodyweight decreased with saxagliptin, but increased with glimepiride over the treatment period, and the treatment difference was −1.6 kg (P < 0.001) at Week 48. The proportion of patients experiencing hypoglycaemia was much lower with saxagliptin vs glimepiride (3.1% vs 12.8%; P < 0.001).Conclusions: This study provides evidence that, compared to glimepiride, saxagliptin more effectively achieves a composite endpoint of adequate glycaemic control without hypoglycaemia and without weight gain in T2D patients who are inadequately controlled with metformin monotherapy, especially in overweight patients with moderate hyperglycaemia and a relatively short duration of diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparative effect of saxagliptin and glimepiride with a composite endpoint of adequate glycaemic control without hypoglycaemia and without weight gain in patients uncontrolled with metformin therapy: Results from the SPECIFY study, a 48‐week, multi‐centre, randomized, controlled trial

Zhang

et al. 2019

Diabetes Obesity Metabolism

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“…[13] A recent study found the treatment pathway with DPP-4 inhibitors as the cost-effective second-line therapy compared to sulfonylureas from the US health care payer perspective. [14] There had been no direct comparison for cost-effectiveness of teneligliptin with sulfonylureas as combination therapy with metformin in Indian T2DM patients. So, this study was undertaken to evaluate the relative cost-effectiveness of these two combination therapies.…”

Section: Discussionmentioning

confidence: 99%

A pharmacoeconomic analysis to compare cost-effectiveness of metformin plus teneligliptin with metformin plus glimepiride in patients of type-2 diabetes mellitus

Tandon

Dubey

Srivastava

et al. 2019

J Family Med Prim Care

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Background: With the available evidence of early combined oral drug therapies being more effective in lowering blood glucose levels than maximal doses of a single drug, many clinicians are taking the aggressive approach of adding a sulfonylurea or a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin as the initial therapy in type 2 diabetes mellitus (T2DM). Pharmacotherapy for a chronic disease like diabetes has substantial economic implications for patients especially in a developing country like India. So it is important to scientifically evaluate the cost-effectiveness of these commonly practiced combination therapies in the management of T2DM. Materials and Methods: This was a prospective observational randomized comparative study conducted over 8 weeks on patients of T2DM who were prescribed either of the two therapies of metformin (500 mg) plus glimepiride (1 mg) or metformin (500 mg) plus teneligliptin (20 mg). Cost-effectiveness analysis was done by calculating the expense incurred on 0.1% reduction in HbA1 c and 1 mg/dl reduction in fasting plasma glucose (FPG)/post-prandial plasma glucose (PPG) levels after 8 weeks and compared for both the groups. The same was also evaluated for differences in BMI levels. Results: The cost-effectiveness for per unit reduction in HbA1c and FPG was significant in metformin plus glimepiride group as compared to the metformin plus teneligliptin group though it was comparable for both the groups for per unit PPG reduction. There was no significant change in BMI levels between the groups. Conclusion: Compared to metformin plus teneligliptin, metformin plus glimepiride is a significantly cost-effective therapy when used as an initial combination therapy in patients of T2DM in lowering HbA1c and FPG.

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“…Notably, alogliptin is available as FDCs; thus, pill burden and pharmacy dispensing fees may allow for adherence improvement and further cost savings, respectively [89]. Studies have reported that alogliptin in combination with metformin is an alternative, cost-effective treatment compared with SUs in patients with T2DM [90, 91]. In a UK study, long-term alogliptin + metformin combination treatment achieved greater estimated lifetime quality-adjusted life-year (QALY) gains compared with SU + metformin; the associated incremental cost-effectiveness ratios (ICERs) were £10,959/QALY (12.5 mg alogliptin) and £7217/QALY (25 mg alogliptin) [90].…”

Section: Benefit Evaluationmentioning

confidence: 99%

Benefit-Risk Assessment of Alogliptin for the Treatment of Type 2 Diabetes Mellitus

et al. 2019

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The dipeptidyl peptidase-4 inhibitor (DPP-4i) alogliptin is an oral, antidiabetic treatment that is approved in many countries to treat patients with type 2 diabetes mellitus (T2DM), including the USA, Europe, and Japan. Alogliptin is efficacious both as monotherapy and as add-on/combination therapy with other commonly prescribed T2DM treatments, such as metformin and pioglitazone. Overall, alogliptin is well-tolerated in patients with T2DM, including older patients, those with renal and/or hepatic impairment, and those at high risk of cardiovascular events. There is a low risk of hypoglycemia, weight gain, acute pancreatitis, and gastrointestinal adverse events with alogliptin treatment, as demonstrated in long-term trials (lasting up to 4.5 years) and in a real-world setting. Additionally, alogliptin has a generally favorable or similar safety profile in comparison to other antidiabetic agents (metformin, thiazolidinediones, sulfonylureas, glucagon-like peptide-1 receptor agonists, sodiumglucose cotransporter 2 inhibitors, α-glucosidase inhibitors, and insulin). However, further evaluation would be required to determine the mechanism and effect of alogliptin on heart failure, bullous pemphigoid, and inflammatory bowel disease. Of note, due to the ethnic diversity in the epidemiology of T2DM, alogliptin has been shown to be more efficacious in Asian patients than in non-Asian patients with T2DM, but with a similar tolerability profile. These data indicate that DPP-4is, including alogliptin, are important treatment options, especially for Asian patients with T2DM, for whom they have potential as a first-line therapy. This benefit-risk assessment aims to place alogliptin within the current armamentarium of T2DM and aid physicians when choosing optimal diabetes treatment for their patients.

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Cost-effectiveness analysis of metformin+dipeptidyl peptidase-4 inhibitors compared to metformin+sulfonylureas for treatment of type 2 diabetes

Cited by 28 publications

References 31 publications

Comparative effect of saxagliptin and glimepiride with a composite endpoint of adequate glycaemic control without hypoglycaemia and without weight gain in patients uncontrolled with metformin therapy: Results from the SPECIFY study, a 48‐week, multi‐centre, randomized, controlled trial

Comparative effect of saxagliptin and glimepiride with a composite endpoint of adequate glycaemic control without hypoglycaemia and without weight gain in patients uncontrolled with metformin therapy: Results from the SPECIFY study, a 48‐week, multi‐centre, randomized, controlled trial

A pharmacoeconomic analysis to compare cost-effectiveness of metformin plus teneligliptin with metformin plus glimepiride in patients of type-2 diabetes mellitus

Benefit-Risk Assessment of Alogliptin for the Treatment of Type 2 Diabetes Mellitus

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