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COST-UTILITY ANALYSIS OF LIRAGLUTIDE VERSUS GLIMEPIRIDE AS ADD-ON TO METFORMIN IN TYPE 2 DIABETES PATIENTS IN CHINA

Published online by Cambridge University Press:  24 September 2012

Lan Gao ,
Fei-Li Zhao  and
Shu-Chuen Li
Lan Gao
Affiliation:
School of Biomedical Sciences & Pharmacy, University of Newcastle email: ShuChuen.Li@newcaslte.edu.au
Fei-Li Zhao
Affiliation:
School of Biomedical Sciences & Pharmacy, University of Newcastle email: ShuChuen.Li@newcaslte.edu.au
Shu-Chuen Li
Affiliation:
School of Biomedical Sciences & Pharmacy, University of Newcastle email: ShuChuen.Li@newcaslte.edu.au
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Abstract

Objectives: The aim of this study was to evaluate the long-term cost-utility of liraglutide versus glimepiride as add-on therapy to metformin in patients with type 2 diabetes mellitus (T2DM), based on the results of clinical trial conducted in Asian population.

Methods: The validated UKPDS Outcomes Model was used to project life expectancy, quality adjusted life-years (QALYs), incidence of diabetes-related complication and cost of complications in patients receiving those regimens. Baseline cohort characteristics and treatment effects were derived from an Asian study. China-specific complication costs and utility score were taken from local studies. Patients’ outcomes were modeled for 30 years and incremental cost-effectiveness ratios were calculated for liraglutide compared with glimepiride from the healthcare system perspective. Both future costs and clinical benefits were discounted at 3 percent. Sensitivity analyses were performed.

Results: Over a period of 30 years, compared with glimepiride, liraglutide 1.8 mg was associated with improvements in life expectancy (0.1 year) and quality adjusted life-year (0.168 QALY), and a reduced incidence of diabetes-related complications leading to an incremental cost-effectiveness ratio per QALY gained versus glimepiride of CNY 25,6871 (DEC 2010, 1 USD = 6.6227 CNY).

Conclusions: Long-term projections indicated that liraglutide was associated with increased life expectancy, QALYs, and reduced complication incidences comparing with glimepiride. When the UK cost of liraglutide was discounted by 38 percent, liraglutide would be a cost-effective option in China from the healthcare system perspective using the 3X GDP/capita per QALY as the WTP threshold.

Keywords

Cost-effectivenessCost-utility analysisLiraglutideGlimepirideType 2 diabetes mellitusUKPDS Outcomes Model
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 4 , October 2012 , pp. 436 - 444
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

1.Borgstrom, F, Johnell, O, Kanis, J. At what hipfracture risk is it cost-effective to treat? International intervention threshold for the treatment of osteoporosis. Osteoporos Int. 2006;17:1459–1471.CrossRefGoogle Scholar
2.Buse, JB, Rosenstock, J, Sesti, G, et al.Liraglutide once a day versus exenatide twice a day for type 2 diabetes: A 26-week randomised, parallel-group, multinational, open-label trial (LEAD-6). Lancet. 2009;374:39–47.CrossRefGoogle Scholar
3.Chen, Z, Zhang, S, Yang, L, et al.Association between side effects of oral anti-diabetic drugs and self-reported mental health and quality of life among patients with type 2 diabetes. Natl Med J China. 2011;91:229–233. In ChineseGoogle ScholarPubMed
4.Clarke, P, Gray, A, Holman, R. Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Med Decis Making. 2002;22:340–349.CrossRefGoogle ScholarPubMed
5.Clarke, P, Gray, AM, Briggs, AH, et al.A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68). Diabetologe. 2004;47:1747–1759.CrossRefGoogle Scholar
6.Davies, MJ, Chubb, BD, Smith, IC, Valentine, WJ. Cost-utility analysis of liraglutide compared with sulphonylurea or sitagliptin, all as add-on to metformin monotherapy in Type 2 diabetes mellitus. Diabet Med. 2012;29:313–320.CrossRefGoogle ScholarPubMed
7.Dolezal, T, Niewada, M, Rychna, K, Czech, M. Long-term cost-effectiveness of liraglutide vs. rosiglitazone in the Czech Republic. In: ISPOR 13th Annual European Congress, 2010, Prague, Czech Republic.CrossRefGoogle Scholar
8.Flint, A, Raben, A, Astrup, A, Holst, JJ. Glucagon-like peptide 1 promotes satiety and suppresses energy intake in humans. J Clin Invest. 1998;101:515–520.CrossRefGoogle ScholarPubMed
9.Garber, A, Henry, R, Ratner, R, et al.Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): A randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet. 2009;373:473–481.CrossRefGoogle Scholar
10.Gutzwiller, JP, Goke, B, Drewe, J, et al.Glucagon-like peptide-1: A potent regulator of food intake in humans. Gut. 1999;44:81–86.CrossRefGoogle ScholarPubMed
11.Ilavska, A, Uliciansky, V, Wrona, W, Lacka, J, Czech, M. Cost-effectiveness of liraglutide in people with type 2 diabetes in the Slovak Republic. In: ISPOR 13th Annual European Congress, 2010, Prague, Czech Republic.CrossRefGoogle Scholar
12.Jia, WP, Pang, C, Chen, L. Epidemiology characteristics of diabetes mellitus and impaired glucose regulation in a chinese adult population: The shanghai diabetes studies, a cross-sectional 3-year follow-up study in shanghai urban communities. Diabetologia. 2007;50:286–292.CrossRefGoogle Scholar
13.Jonsson, B. Revealing the cost of Type II diabetes in Europe. Diabetologia. 2002;45:S5–12.CrossRefGoogle ScholarPubMed
14.Kahn, SE, Zinman, B, Lachin, JM, et al.Rosiglitazone-associated fractures in type 2 diabetes: An analysis from A Diabetes Outcome Progression Trial (ADOPT). Diabetes Care. 2008;31:845–851.CrossRefGoogle ScholarPubMed
15.Kiberd, BA and Jindal, KK. Screening to prevent renal failure in insulin dependent diabetic patients: An economic evaluation. BMJ. 1995;311:1595–1599.CrossRefGoogle ScholarPubMed
16.Lee, WC, Conner, C, Hammer, M. Results of a model analysis of the cost-effectiveness of liraglutide versus exenatide added to metformin, glimepiride, or both for the treatment of type 2 diabetes in the United States. Clin Ther. 2010;32:1756–1767.CrossRefGoogle ScholarPubMed
17.Marre, M, Shaw, J, Brandle, M, et al.Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with Type 2 diabetes (LEAD-1 SU). Diabet Med. 2009;26:268–278.CrossRefGoogle ScholarPubMed
18.Mu, PW, Chen, YM, Lu, HY, et al.Effects of a combination of oral antidiabetes drugs with basal insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes. Diabetes Metab Res Rev. 2012;28:236–240.CrossRefGoogle Scholar
19.Murray, CJ, Lauer, JA, Hutubessy, RC, et al.Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: A global and regional analysis on reduction of cardiovascular-disease risk. Lancet. 2003;361:717–725.CrossRefGoogle ScholarPubMed
20.Naslund, E, Gryback, P, Backman, L, et al.Distal small bowel hormones: Correlation with fasting antroduodenal motility and gastric emptying. Dig Dis Sci. 1998;43:945–952.CrossRefGoogle ScholarPubMed
21.Nauck, M, Frid, A, Hermansen, K, et al.Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: The LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care. 2009;32:84–90.CrossRefGoogle Scholar
22.NICE. NICE recommends liraglutide for type 2 diabetes mellitus. http://www.nice.org.uk/newsroom/pressreleases/2010156liraglutidepressrelease.jsp (accessed Month day, year).Google Scholar
23.NICE. Final Appraisal Determination.Liraglutide for the Treatment of Type 2 Diabetes. http://www.nice.org.uk/nicemedia/live/11895/50663/50663.pdf (accessed 14 January 14, 2011).Google Scholar
24.Niewada, M, Wrona, W, Czech, M, Schubert, A, Skrzekowska-Baran, I. Long-term cost-effectiveness of liraglutide vs. sulphonylurea in Poland. In: ISPOR 13th Annual European Congress, 2010, Prague, Czech Republic.CrossRefGoogle Scholar
25.Palmer, JL, Beaudet, A, White, J, Plun-Favreau, J, Smith-Palmer, J. Cost-effectiveness of biphasic insulin aspart versus insulin glargine in patients with type 2 diabetes in China. Adv Ther. 2010;27:814–827.CrossRefGoogle ScholarPubMed
26.Palmer, JL, Gibbs, M, Scheijbeler, HW, et al.Cost-effectiveness of switching to biphasic insulin aspart in poorly-controlled type 2 diabetes patients in China. Adv Ther. 2008;25:752–774.CrossRefGoogle ScholarPubMed
27.Ranganath, LR, Beety, JM, Morgan, LM, et al.Attenuated GLP-1 secretion in obesity: Cause or consequence? Gut. 1996;38:916–919.CrossRefGoogle ScholarPubMed
28.Russell-Jones, D, Vaag, A, Schmitz, O, et al.Liraglutide vs insulin glargine and placebo in combination with metformin and sulfonylurea therapy in type 2 diabetes mellitus (LEAD-5 met+SU): A randomised controlled trial. Diabetologia. 2009;52:2046–2055.CrossRefGoogle ScholarPubMed
29.Sullivan, SD, Alfonso-Cristancho, R, Conner, C, Hammer, M, Blonde, L. Long-term outcomes in patients with type 2 diabetes receiving glimepiride combined with liraglutide or rosiglitazone. Cardiovasc Diabetol. 2009;8:12.CrossRefGoogle ScholarPubMed
30.Tang, L, Chen, X, Chen, H. The economic burden of type 2 diabetes mellitus and its complications in the cities of China. Chin Health Econ Mag. 2003;22:21–23. In Chinese.Google Scholar
31.Thomas, GN, Critchley, JA, Tomlinson, B, Cockram, CS, Chan, JC. Peripheral vascular disease in Type 2 diabetic Chinese patients: Associations with metabolic indices, concomitant vascular disease and genetic factors. Diabet Med. 2003;20:988–995.CrossRefGoogle ScholarPubMed
32.Turner, RC. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) (vol 352, pg 837, 1998). Lancet. 1999;354:602–602.Google Scholar
33.Valentine, WJ, Palmer, AJ, Lammert, M, Langer, J, Brandle, M. Evaluating the long-term cost-effectiveness of liraglutide versus exenatide BID in patients with type 2 diabetes who fail to improve with oral antidiabetic agents. Clin Ther. 2011;33:1698–1712.CrossRefGoogle ScholarPubMed
34.Valentine, WJ, Palmer, AJ, Nicklasson, L, Cobden, D, Roze, S. Improving life expectancy and decreasing the incidence of complications associated with type 2 diabetes: A modelling study of HbA1c targets. Int J Clin Pract. 2006;60:1138–1145.CrossRefGoogle ScholarPubMed
35.WHO. Report on macroeconomics and health: Investing in Health for Economic development. Geneva: World Health Organization; 2001.Google Scholar
36.WHO. Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: World Health Organization; 2003.Google Scholar
37.Williams, R, Van Gaal, L, Lucioni, C. Assessing the impact of complications on the costs of Type II diabetes. Diabetologia. 2002;45:S13–17.CrossRefGoogle ScholarPubMed
38.Wu, J, Wu, JH, Chang, J. Long-Term health outcomes of treatment with liraglutide versus glimepriride in Type 2 diabetes patients in asian setting. In: ISPOR 4th Asia-Pacific Conference, 2010, Phuket, Thailand.CrossRefGoogle Scholar
39.Xie, X, Vondeling, H. Cost-utility analysis of intensive blood glucose control with metformin versus usual care in overweight type 2 diabetes mellitus patients in Beijing, P.R. China. Value Health. 2008;11 (Suppl 1):S23–32.CrossRefGoogle ScholarPubMed
40.Xu, L, Xie, X, Wang, S, Wang, Y, Jonas, JB. Prevalence of diabetes mellitus in China. Exp Clin Endocrinol Diabetes. 2008;116:69–70.CrossRefGoogle ScholarPubMed
41.Yang, W, Chen, L, Ji, Q, et al.Liraglutide provides similar glycaemic control as glimepiride (both in combination with metformin) and reduces body weight and systolic blood pressure in Asian population with type 2 diabetes from China, South Korea and India: A 16-week, randomized, double-blind, active control trial. Diabetes Obes Metab. 2011;13:81–88.CrossRefGoogle ScholarPubMed
42.Zhou, X, Ji, L, Luo, Y, et al.Organization and delivery of care performance of HbA1c for detecting newly diagnoseddiabetes and pre-diabetes in Chinese communities living in Beijing. Diabet Med. 2009;26:1262.CrossRefGoogle Scholar
43.Zinman, B, Gerich, J, Buse, JB, et al.Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD). Diabetes Care. 2009;32:1224–1230.CrossRefGoogle Scholar
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