Published: Pharmacoeconomics – Spanish Research Articles, 2016
Objectives
To evaluate the cost-effectiveness of saxagliptin versus sulfonylurea (glipizide) added to metformin in patients with type 2 diabetes mellitus (T2DM) from a US payer perspective.
Study Design
Data from a 52-week randomized controlled trial comparing saxagliptin and glipizide in combination with metformin were used in a simulation model to estimate long-term health outcomes in a cohort of T2DM patients.
Methods
Evidence from a clinical trial and other published literature were used to assess disease progression rates and associated healthcare costs. Subjects were simulated in yearly time increments, and the model estimated the 5-year and lifetime (ie, 40-year) clinical and economic outcomes, taking into account the cost and disutility associated with weight gain and hypoglycemia events. The model estimated the incidence of microvascular and macrovascular complications, diabetes-specifi c mortality, all-cause mortality, and costs and quality-adjusted life-years (QALYs) associated with the treatment strategies.
Results
The analysis suggests that compared with glipizide plus metformin the 5-year QALY gain for saxagliptin plus metformin was 0.53 with a cost of $13,374 per QALY. At 40 years, lifetime QALY gain for saxagliptin plus metformin rose to 2.64 per patient and cost per QALY was reduced to $1052. Sensitivity analysis indicated disutility values were a key driver, whereas the impact of overall costs was more modest.
Conclusions
Over a T2DM patient’s lifetime, addition of saxagliptin to metformin is associated with improvement in QALYs when considering cost and disutility due to treatment side effects. Cost effectiveness is within acceptable cost-effectiveness threshold in the United States.
