Cost‐effectiveness of exenatide twice daily vs insulin glargine as add‐on therapy to oral antidiabetic agents in patients with type 2 diabetes in China

Gu, Shi-Jian; Wang, Xiaoyong; Qiao, Qing; Gao, Weiguo; Wang, Jian; Dong, Hengjin

doi:10.1111/dom.12991

Cited by 13 publications

(11 citation statements)

References 48 publications

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“…Of the 864 identified studies, 56 studies were eligible for the meta-analysis (see figure 1). From the 56 studies, 82 comparisons were assessed, including GLP1 versus DPP4i (n=10) [18][19][20][21][22][23][24][25][26][27] ; GLP1 versus sulfonylureas (n=7) 20 25-30 ; GLP1 versus thiazolidines (n=3) 21 30 31 ; GLP1 versus insulins (n=27, 23 HICs 19 30-52 and 3 UMICs [53][54][55] ); GLP1 versus insulin plus DPP4i (n=2), 45 56 or insulin plus sulfonylureas (n=2), 52 57 GLP1 versus insulin plus GLP1 (n=5) 36 42 46 55 58 and insulin degludec/liraglutide (IDeg-Lira) versus insulin (n=7). 34-36 42 46 48 59 Among GLP1s, treatment comparisons included liraglutide versus exenatide (n=7) 43 56 60-64 and liraglutide versus lixisenatide (n=5).…”

Section: Resultsmentioning

confidence: 99%

“…Among the studies looking at GLP1s versus insulins, 24 and 3 [53][54][55] were from HICs and UMICs. One study 51 9A); that is, GLP1s were cost-effective compared with insulins in HICs.…”

Section: Glp1 Versus Insulinsmentioning

confidence: 99%

“…GLP1s were not cost-effective compared with insulins in UMICs (n=3 [53][54][55] .07, p=0.013) showed asymmetry; a contour-enhanced funnel plot suggested that this may be due to both heterogeneity and missing studies (see online supplementary figure 13A,B).…”

Section: Glp1 Versus Insulinsmentioning

confidence: 99%

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Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies

Bagepally

Chaikledkaew

Gurav

et al. 2020

BMJ Open Diab Res Care

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ObjectivesTo conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure.Research design and methodsThe study design is a systematic review and meta-analysis. We searched MEDLINE (via PubMed), Scopus and Tufts Registry for eligible cost–utility studies up to June 2018, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We conducted a systematic review and pooled the INBs of GLP1s compared with other therapies in T2DM after metformin monotherapy failure. Various monetary units were converted to purchasing power parity, adjusted to 2017 US$. The INBs were calculated and then pooled across studies, stratified by level of country income; a random-effects model was used if heterogeneity was present, and a fixed-effects model if it was absent. Heterogeneity was assessed using Q test and I2 statistic.ResultsA total of 56 studies were eligible, mainly from high-income countries (HICs). The pooled INBs of GLP1s compared with dipeptidyl peptidase-4 inhibitor (DPP4i) (n=10), sulfonylureas (n=6), thiazolidinedione (TZD) (n=3), and insulin (n=23) from HICs were US$4012.21 (95% CI US$−571.43 to US$8595.84, I2=0%), US$3857.34 (95% CI US$−7293.93 to US$15 008.61, I2=45.9%), US$37 577.74 (95% CI US$−649.02 to US$75 804.50, I2=92.4%) and US$14 062.42 (95% CI US$8168.69 to US$19 956.15, I2=86.4%), respectively. GLP1s were statistically significantly cost-effective compared with insulins, but not compared with DPP4i, sulfonylureas, and TZDs. Among GLP1s, liraglutide was more cost-effective compared with lixisenatide, but not compared with exenatide, with corresponding pooled INBs of US$4555.09 (95% CI US$3992.60 to US$5117.59, I2=0) and US$728.46 (95% CI US$−1436.14 to US$2893.07, I2=0), respectively.ConclusionGLP1 agonists are a cost-effective choice compared with insulins, but not compared with DPP4i, sulfonylureas and TZDs.PROSPERO registration numberCRD42018105193.

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Section: Resultsmentioning

confidence: 99%

“…Among the studies looking at GLP1s versus insulins, 24 and 3 [53][54][55] were from HICs and UMICs. One study 51 9A); that is, GLP1s were cost-effective compared with insulins in HICs.…”

Section: Glp1 Versus Insulinsmentioning

confidence: 99%

See 1 more Smart Citation

Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies

Bagepally

Chaikledkaew

Gurav

et al. 2020

BMJ Open Diab Res Care

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“…Palmer et al, Wu et al, Li et al, and Chen et al evaluated the cost-effectiveness of different types of insulins using CORE diabetes model [369][370][371][372][373]. Gu et al and Shao et al estimated the costeffectiveness of saxagliptin (or dapagliflozin) vs. acarbose (or glimepiride), and exenatide vs. insulin glargine using the Cardiff diabetes model [374][375][376][377][378]. Zhu and Chen assessed the cost-effectiveness of vildagliptin vs. pioglitazone vs. glimepiride, and sitagliptin vs. glimepiride vs. acarbose as add-on therapy to metformin using UKPDS model [379,380].…”

Section: Discussionmentioning

confidence: 99%

Choice across 10 pharmacologic combination strategies for type 2 diabetes: a cost-effectiveness analysis

Shi

Shao

et al. 2020

BMC Med

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Background Clinical guidelines recommend a stepped-escalation treatment strategy for type 2 diabetes (T2DM). Across multiple treatment strategies varying in efficacy and costs, no clinical or economic studies directly compared them. This study aims to estimate and compare the cost-effectiveness of 10 commonly used pharmacologic combination strategies for T2DM. Methods Based on Chinese guideline and practice, 10 three-stepwise add-on strategies were identified, which start with metformin, then switch to metformin plus one oral drug (i.e., sulfonylurea, thiazolidinedione, α-glucosidase inhibitor, glinide, or DPP-4 inhibitor) as second line, and finally switch to metformin plus one injection (i.e., insulin or GLP-1 receptor agonist) as third line. A cohort of 10,000 Chinese patients with newly diagnosed T2DM was established. From a healthcare system perspective, the Cardiff model was used to estimate the cost-effectiveness of the strategies, with clinical data sourced from a systematic review and indirect treatment comparison of 324 trials, costs from claims data of 1164 T2DM patients, and utilities from an EQ-5D study. Outcome measures include costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefits (NMBs). Results Over 40-year simulation, the costs accumulated for a patient ranged from $7661 with strategy 1 to $14,273 with strategy 10, while the QALY gains ranged from 13.965 with strategy 1 to 14.117 with strategy 8. Strategy 7 was dominant over seven strategies (strategies 2~6, 9~10) with higher QALYs but lower costs. Additionally, at a willingness-to-pay threshold of $30,787/QALY (i.e., 3 times GDP/capita for China), strategy 7 was cost-effective compared with strategy 1 (ICER of strategy 7 vs. 1, $3371/QALY) and strategy 8 (ICER of strategy 8 vs. 7, $132,790/QALY). Ranking the strategies by ICERs and NMBs, strategy 7 provided the best value for money when compared to all other strategies, followed by strategies 5, 9, 8, 1, 3, 6, 10, 2, and 4. Scenario analyses showed that patients insist on pharmacologic treatments increased their QALYs (0.456~0.653) at an acceptable range of cost increase (ICERs, $1450/QALY~$12,360/QALY) or even at cost saving compared with those not receive treatments. Conclusions This study provides evidence-based references for diabetes management. Our findings can be used to design the essential drug formulary, infer clinical practice, and help the decision-maker design reimbursement policy.

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“…The incorporation of real-world effectiveness and cost data into CEA complements the evidence derived from clinical trials and ensures that the results will be relevant for the real-life healthcare decision-making context [7,8]. However, most CEAs of GLP-1RA versus insulin therapy for T2D patients have been model-based (e.g., Markov modeling simulation) analyses that used data mainly derived from clinical trials that assessed short-term drug efficacy in terms of biomarker changes among highly selective and homogenous patient populations [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Such approaches greatly affect the generalizability of study results to real-world settings and raise concerns about the validity of projecting the results to long-term outcomes.…”

mentioning

confidence: 99%

Cost-effectiveness of GLP-1 receptor agonists versus insulin for the treatment of type 2 diabetes: a real-world study and systematic review

Chen

et al. 2021

Cardiovasc Diabetol

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Background To conduct a real-word-study-based cost-effectiveness analysis of a GLP-1 receptor agonist (GLP-1RA) versus insulin among type 2 diabetes patients requiring intensified injection therapy and a systematic review of cost-effectiveness studies of GLP-1RAs versus insulin. Methods Individual-level analyses incorporating real-world effectiveness and cost data were conducted for a cohort of 1022 propensity-score-matched pairs of GLP-1RA and insulin users from Taiwan’s National Health Insurance Research Database, 2007–2016. Study outcomes included the number needed to treat (NNT) to prevent one case of clinical events, healthcare costs, and cost per case of event prevented. Costs were in 2019 US dollars. Analyses were performed from a third-party payer and healthcare sector perspectives. Structured systematic review procedures were conducted to synthesize updated evidence on the cost-effectiveness of GLP-1RAs versus insulin. Results Over a mean follow-up of 2.3 years, the NNT using a GLP-1RA versus insulin to prevent one case of all-cause mortality and hospitalized hypoglycemia was 57 and 30, respectively. Using GLP-1RAs instead of insulin cost US$54,851 and US$29,115 per case of all-cause mortality and hospitalized hypoglycemia prevented, respectively, from the payer perspective, and saved US$19,391 and US$10,293, respectively, from the healthcare sector perspective. Sensitivity analyses showed that the probability of using GLP-1RAs versus insulin being cost-effective for preventing one case of all-cause mortality or hospitalized hypoglycemia ranged from 60 to 100%. The systematic review revealed a cost-effective profile of using GLP-1RAs versus insulin. Conclusions Using GLP-1RAs versus insulin for type 2 diabetes patients requiring intensified injection therapy in clinical practice is cost-effective.

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Cost‐effectiveness of exenatide twice daily vs insulin glargine as add‐on therapy to oral antidiabetic agents in patients with type 2 diabetes in China

Abstract: In Chinese patients with T2DM inadequately controlled by OADs, exenatide twice daily is a cost-effective add-on therapy alternative to insulin glargine once daily, and may address the problem of an excess of medical needs resulting from weight gain and hypoglycaemia in T2DM treatment.

Cited by 13 publications

References 48 publications

Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies

Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies

Choice across 10 pharmacologic combination strategies for type 2 diabetes: a cost-effectiveness analysis

Cost-effectiveness of GLP-1 receptor agonists versus insulin for the treatment of type 2 diabetes: a real-world study and systematic review

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