The Cost-effectiveness of Dulaglutide 1.5mg versus Exenatide QW for the Treatment of Patients with Type 2 Diabetes Mellitus in France

Abstract

IntroductionDulaglutide is a novel onceweekly administered glucagon-like peptide 1 receptor agonist (GLP-1 RA) for the management of type 2 diabetes mellitus (T2DM). The objective of this analysis was to estimate the cost-effectiveness of dulaglutide 1.5 mg versus exenatide QW for the management of T2DM in France.MethodsThe QuintilesIMS CORE Diabetes Model was used to estimate the expected lifetime direct medical costs and outcomes of T2DM from the perspective of the French National Health Service. In the absence of head-to-head data, relative efficacy was derived from a network meta-analysis. Patient cohort characteristics were derived from the AWARD-2 trial. All patients were assumed to remain on treatment for 2 years before escalating to insulin therapy. Costs included treatment costs and costs associated with long-term complications of T2DM. Utilities were estimated based on a recent systematic review. One-way sensitivity analyses (OWSA) and probabilistic sensitivity analysis (PSA) were conducted. Cost-effectiveness acceptability curves (CEACs) were generated.ResultsDulaglutide 1.5 mg was associated with lower costs (lifetime costs €41,562 vs €43,021) and increased health benefits (lifetime quality-adjusted life years: QALYs 9.804 vs 9.757) versus exenatide QW for the treatment of T2DM in France. OWSA and PSA indicated that results were robust across a range of plausible input parameters. The CEAC indicated a 99.5% probability that dulaglutide would be considered cost-effective at a willingness to pay of €30,000.ConclusionDulaglutide 1.5 mg reduced expected costs and increased expected QALYs when compared against exenatide QW for the treatment of T2DM in France. Compared with exenatide QW, dulaglutide 1.5 mg can provide additional health benefits for patients with T2DM and may result in cost savings for payers.FundingEli Lilly.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0321-0) contains supplementary material, which is available to authorized users.

Patient characteristics of insulin lispro 200 units/mL users in real world setting in Germany

“…The Data Protection Commissioner of the data protection agency of the German Federal state Hesse endorses the data transmission, processing, and storage procedures for DA. DA has been used in other studies focusing on different outcomes in diabetes treatment [16][17][18] .…”

A systematic review of economic evaluations in non-insulin antidiabetic treatments for patients with type 2 diabetes mellitus

“…The results were not conclusive for the aGLP-1. 20,21,23,25,33,35–66 Albiglutide appeared to be a more cost-effective option than sitagliptin, 35 but the results were the opposite when comparing the general subgroups to which these NIADs belonged (aGLP-1 versus iDPP-4). 20 Exenatide was a more cost-effective treatment than another analogue such as lixisenatide (ICER of €12,600/QALY), 36 but no conclusive results were obtained in comparison with other analogues such as liraglutide, 36–41 or dulaglutide.…”

“…39,47–49 Dulaglutide was dominant over liraglutide, 46 but contradictory results were obtained versus exenatide. 36,42…”

Cost-Effectiveness Analysis of Exenatide versus GLP-1 Receptor Agonists in Patients with Type 2 Diabetes Mellitus

“…In a review of the literature, four economic analyses were identified comparing one GLP-1 receptor agonist with another. These studies were conducted in France [45], Italy [46], the UK [47], and Spain [48]. The diversity of methods and treatment alternatives used in these analyses prevented comparing the conclusions with those of the present study.…”