Limits...
Cost-effectiveness of dipeptidyl peptidase-4 inhibitor monotherapy in elderly type 2 diabetes patients in Thailand

View Article: PubMed Central - PubMed

ABSTRACT

Background: The management of type 2 diabetes mellitus (T2DM) in elderly population poses many challenges. Dipeptidyl peptidase-4 (DPP-4) inhibitors show particular promise due to excellent tolerability profiles, low risk of hypoglycemia, and little effect on body weight. This study evaluated, from the health care system’s perspective, the long-term cost-effectiveness of DPP-4 inhibitor monotherapy vs metformin and sulfonylurea (SFU) monotherapy in Thai elderly T2DM patients.

Methods: The clinical efficacy was estimated from a systematic review and meta-analysis. Baseline cohort characteristics and cost parameters were obtained from published studies and hospital databases in Thailand. A validated IMS CORE Diabetes Model version 8.5 was used to project clinical and economic outcomes over a lifetime horizon using a 3% annual discount rate. Costs were expressed in 2014 Thai Baht (THB) (US dollar value). Incremental cost-effectiveness ratios were calculated. Base-case assumptions were assessed through several sensitivity analyses.

Results: For treating elderly T2DM patients, DPP-4 inhibitors were more expensive and less effective, ie, a dominated strategy, than the metformin monotherapy. Compared with SFU, treatment with DPP-4 inhibitors gained 0.031 more quality-adjusted life years (QALYs) at a total cost incurred over THB113,701 or US$3,449.67, resulting in an incremental cost-effectiveness ratio of THB3.63 million or US$110,133.50 per QALY. At the acceptable Thai ceiling threshold of THB160,000/QALY (US$4,854.37/QALY), DPP-4 inhibitors were not a cost-effective treatment.

Conclusion: DPP-4 inhibitor monotherapy is not a cost-effective treatment for elderly T2DM patients compared with metformin monotherapy and SFU monotherapy, given current resource constraints in Thailand.

No MeSH data available.


Related in: MedlinePlus

Tornado diagram of saxagliptin vs sulfonylurea in elderly T2DM patients.Abbreviations: DPP-4, dipeptidyl peptidase-4; QALY, quality-adjusted life year; T2DM, type 2 diabetes mellitus; THB, Thai Baht.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC5036830&req=5

f1-ceor-8-521: Tornado diagram of saxagliptin vs sulfonylurea in elderly T2DM patients.Abbreviations: DPP-4, dipeptidyl peptidase-4; QALY, quality-adjusted life year; T2DM, type 2 diabetes mellitus; THB, Thai Baht.

Mentions: As vildagliptin and sitagliptin were dominated by saxagliptin, the results of one-way sensitivity analysis, therefore, were displayed on saxagliptin compared to SFU. The change in HbA1c from the baseline of DPP-4 inhibitors, discount rate, risk of severe hypoglycemia, and cost of saxagliptin had some effect on the incremental cost-effectiveness ratio (ICER) (Figure 1). The greater the effect of DPP-4 inhibitors on the reduction of HbA1c from baseline, the lower ICER (Figure 1). Based on the cost-effectiveness acceptability curve (Figure 2), all DPP-4 inhibitors were not a cost-effective treatment compared to SFU at the ceiling threshold of 160,000 THB/QALY. Compared to metformin, the probability of DPP-4 inhibitors being cost-effective was even smaller than being compared to SFU.


Cost-effectiveness of dipeptidyl peptidase-4 inhibitor monotherapy in elderly type 2 diabetes patients in Thailand
Tornado diagram of saxagliptin vs sulfonylurea in elderly T2DM patients.Abbreviations: DPP-4, dipeptidyl peptidase-4; QALY, quality-adjusted life year; T2DM, type 2 diabetes mellitus; THB, Thai Baht.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5036830&req=5

f1-ceor-8-521: Tornado diagram of saxagliptin vs sulfonylurea in elderly T2DM patients.Abbreviations: DPP-4, dipeptidyl peptidase-4; QALY, quality-adjusted life year; T2DM, type 2 diabetes mellitus; THB, Thai Baht.
Mentions: As vildagliptin and sitagliptin were dominated by saxagliptin, the results of one-way sensitivity analysis, therefore, were displayed on saxagliptin compared to SFU. The change in HbA1c from the baseline of DPP-4 inhibitors, discount rate, risk of severe hypoglycemia, and cost of saxagliptin had some effect on the incremental cost-effectiveness ratio (ICER) (Figure 1). The greater the effect of DPP-4 inhibitors on the reduction of HbA1c from baseline, the lower ICER (Figure 1). Based on the cost-effectiveness acceptability curve (Figure 2), all DPP-4 inhibitors were not a cost-effective treatment compared to SFU at the ceiling threshold of 160,000 THB/QALY. Compared to metformin, the probability of DPP-4 inhibitors being cost-effective was even smaller than being compared to SFU.

View Article: PubMed Central - PubMed

ABSTRACT

Background: The management of type 2 diabetes mellitus (T2DM) in elderly population poses many challenges. Dipeptidyl peptidase-4 (DPP-4) inhibitors show particular promise due to excellent tolerability profiles, low risk of hypoglycemia, and little effect on body weight. This study evaluated, from the health care system’s perspective, the long-term cost-effectiveness of DPP-4 inhibitor monotherapy vs metformin and sulfonylurea (SFU) monotherapy in Thai elderly T2DM patients.

Methods: The clinical efficacy was estimated from a systematic review and meta-analysis. Baseline cohort characteristics and cost parameters were obtained from published studies and hospital databases in Thailand. A validated IMS CORE Diabetes Model version 8.5 was used to project clinical and economic outcomes over a lifetime horizon using a 3% annual discount rate. Costs were expressed in 2014 Thai Baht (THB) (US dollar value). Incremental cost-effectiveness ratios were calculated. Base-case assumptions were assessed through several sensitivity analyses.

Results: For treating elderly T2DM patients, DPP-4 inhibitors were more expensive and less effective, ie, a dominated strategy, than the metformin monotherapy. Compared with SFU, treatment with DPP-4 inhibitors gained 0.031 more quality-adjusted life years (QALYs) at a total cost incurred over THB113,701 or US$3,449.67, resulting in an incremental cost-effectiveness ratio of THB3.63 million or US$110,133.50 per QALY. At the acceptable Thai ceiling threshold of THB160,000/QALY (US$4,854.37/QALY), DPP-4 inhibitors were not a cost-effective treatment.

Conclusion: DPP-4 inhibitor monotherapy is not a cost-effective treatment for elderly T2DM patients compared with metformin monotherapy and SFU monotherapy, given current resource constraints in Thailand.

No MeSH data available.


Related in: MedlinePlus