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Cost-Effectiveness Analysis of Incretin Therapy for Type 2 Diabetes in Spain: 1.8 mg Liraglutide Versus Sitagliptin.

Pérez A, Mezquita Raya P, Ramírez de Arellano A, Briones T, Hunt B, Valentine WJ - Diabetes Ther (2015)

Bottom Line: Liraglutide was associated with increased direct costs (EUR 56,628 versus EUR 52,450), driven by increased pharmacy costs.Based on these estimates, liraglutide was associated with an incremental cost-effectiveness ratio of EUR 10,436 per QALY gained versus sitagliptin.A previous analysis has suggested that 1.2 mg liraglutide is cost-effective from a healthcare payer perspective in Spain, and the present analysis suggests that the 1.8 mg dose is also likely to be cost-effective.

View Article: PubMed Central - PubMed

Affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

ABSTRACT

Objectives: Metformin is the first-line therapy for most patients with type 2 diabetes, but the majority require treatment intensification at some stage due to the progressive nature of the disease. The 1860-LIRA-DPP-4 trial showed that liraglutide exhibited greater improvements compared with sitagliptin in glycated hemoglobin and body mass index in patients with type 2 diabetes inadequately controlled on metformin monotherapy. As a follow-up to a previously published cost-effectiveness analysis of 1.2 mg liraglutide versus sitagliptin in Spain, the aim of this analysis was to compare long-term projections of the clinical and cost implications associated with 1.8 mg liraglutide and sitagliptin.

Methods: For the modeling analysis, 52-week treatment effect data (as opposed to 26-week data in the previous analysis) were taken from the 1860-LIRA-DPP-4 trial, for adults with type 2 diabetes receiving 1.8 mg liraglutide or 100 mg sitagliptin daily in addition to metformin. Long-term (patient lifetime) projections of clinical outcomes and direct costs (2012 EUR) were made using a published and validated model of type 2 diabetes, with modeling assumptions as per the 1.2 mg liraglutide analysis.

Results: Liraglutide was associated with increased life expectancy (14.24 versus 13.87 years) and quality-adjusted life expectancy [9.24 versus 8.84 quality-adjusted life years (QALYs)] over sitagliptin. Improved clinical outcomes were attributable to the improvement in glycemic control, leading to a reduced incidence of diabetes-related complications, including renal disease, cardiovascular disease, ophthalmic and diabetic foot complications. Liraglutide was associated with increased direct costs (EUR 56,628 versus EUR 52,450), driven by increased pharmacy costs. Based on these estimates, liraglutide was associated with an incremental cost-effectiveness ratio of EUR 10,436 per QALY gained versus sitagliptin.

Conclusions: A previous analysis has suggested that 1.2 mg liraglutide is cost-effective from a healthcare payer perspective in Spain, and the present analysis suggests that the 1.8 mg dose is also likely to be cost-effective.

No MeSH data available.


Related in: MedlinePlus

Mean time to onset of diabetes-related complications with liraglutide and sitagliptin
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Fig1: Mean time to onset of diabetes-related complications with liraglutide and sitagliptin

Mentions: Treatment with liraglutide 1.8 mg was associated with a mean increase in discounted life expectancy of 0.37 years over treatment with sitagliptin (Table 3). Liraglutide was also associated with mean quality-adjusted life expectancy of 9.24 quality-adjusted life years (QALYs), compared to 8.84 QALYs with sitagliptin, a difference of 0.40 QALYs. The clinical benefits in the liraglutide arm were primarily driven by improved glycemic control with liraglutide over sitagliptin, resulting in a reduction in the projected incidence of all diabetes-related complications over patient lifetimes. Of particular note were the reductions in cumulative incidence of diabetic retinopathy, falling from 17.3% to 13.9% (relative risk reduction of 20.1%), and neuropathy, falling from 48.5% to 40.4% (relative risk reduction of 16.7%). The mean time to onset of diabetes-related complications was increased with liraglutide (Fig. 1). The mean time free from any complication was increased from 6.2 years with sitagliptin to 7.4 years with liraglutide, an increase of approximately 20%.Table 3


Cost-Effectiveness Analysis of Incretin Therapy for Type 2 Diabetes in Spain: 1.8 mg Liraglutide Versus Sitagliptin.

Pérez A, Mezquita Raya P, Ramírez de Arellano A, Briones T, Hunt B, Valentine WJ - Diabetes Ther (2015)

Mean time to onset of diabetes-related complications with liraglutide and sitagliptin
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4374077&req=5

Fig1: Mean time to onset of diabetes-related complications with liraglutide and sitagliptin
Mentions: Treatment with liraglutide 1.8 mg was associated with a mean increase in discounted life expectancy of 0.37 years over treatment with sitagliptin (Table 3). Liraglutide was also associated with mean quality-adjusted life expectancy of 9.24 quality-adjusted life years (QALYs), compared to 8.84 QALYs with sitagliptin, a difference of 0.40 QALYs. The clinical benefits in the liraglutide arm were primarily driven by improved glycemic control with liraglutide over sitagliptin, resulting in a reduction in the projected incidence of all diabetes-related complications over patient lifetimes. Of particular note were the reductions in cumulative incidence of diabetic retinopathy, falling from 17.3% to 13.9% (relative risk reduction of 20.1%), and neuropathy, falling from 48.5% to 40.4% (relative risk reduction of 16.7%). The mean time to onset of diabetes-related complications was increased with liraglutide (Fig. 1). The mean time free from any complication was increased from 6.2 years with sitagliptin to 7.4 years with liraglutide, an increase of approximately 20%.Table 3

Bottom Line: Liraglutide was associated with increased direct costs (EUR 56,628 versus EUR 52,450), driven by increased pharmacy costs.Based on these estimates, liraglutide was associated with an incremental cost-effectiveness ratio of EUR 10,436 per QALY gained versus sitagliptin.A previous analysis has suggested that 1.2 mg liraglutide is cost-effective from a healthcare payer perspective in Spain, and the present analysis suggests that the 1.8 mg dose is also likely to be cost-effective.

View Article: PubMed Central - PubMed

Affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

ABSTRACT

Objectives: Metformin is the first-line therapy for most patients with type 2 diabetes, but the majority require treatment intensification at some stage due to the progressive nature of the disease. The 1860-LIRA-DPP-4 trial showed that liraglutide exhibited greater improvements compared with sitagliptin in glycated hemoglobin and body mass index in patients with type 2 diabetes inadequately controlled on metformin monotherapy. As a follow-up to a previously published cost-effectiveness analysis of 1.2 mg liraglutide versus sitagliptin in Spain, the aim of this analysis was to compare long-term projections of the clinical and cost implications associated with 1.8 mg liraglutide and sitagliptin.

Methods: For the modeling analysis, 52-week treatment effect data (as opposed to 26-week data in the previous analysis) were taken from the 1860-LIRA-DPP-4 trial, for adults with type 2 diabetes receiving 1.8 mg liraglutide or 100 mg sitagliptin daily in addition to metformin. Long-term (patient lifetime) projections of clinical outcomes and direct costs (2012 EUR) were made using a published and validated model of type 2 diabetes, with modeling assumptions as per the 1.2 mg liraglutide analysis.

Results: Liraglutide was associated with increased life expectancy (14.24 versus 13.87 years) and quality-adjusted life expectancy [9.24 versus 8.84 quality-adjusted life years (QALYs)] over sitagliptin. Improved clinical outcomes were attributable to the improvement in glycemic control, leading to a reduced incidence of diabetes-related complications, including renal disease, cardiovascular disease, ophthalmic and diabetic foot complications. Liraglutide was associated with increased direct costs (EUR 56,628 versus EUR 52,450), driven by increased pharmacy costs. Based on these estimates, liraglutide was associated with an incremental cost-effectiveness ratio of EUR 10,436 per QALY gained versus sitagliptin.

Conclusions: A previous analysis has suggested that 1.2 mg liraglutide is cost-effective from a healthcare payer perspective in Spain, and the present analysis suggests that the 1.8 mg dose is also likely to be cost-effective.

No MeSH data available.


Related in: MedlinePlus