Jing Deng1, Shuyan Gu2, Hui Shao3, Hengjin Dong2, Dajin Zou4, Lizheng Shi3. 1. a a Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA. 2. b b Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine , Hangzhou , Zhejiang Province , PR China. 3. c c Department of Global Health Systems and Development , School of Public Health and Tropical Medicine, Tulane University , New Orleans , LA , USA. 4. d d Department of Endocrinology , Changhai Hospital, Second Military Medical University , Shanghai , PR China.
Abstract
OBJECTIVE: To estimate cost-effectiveness of exenatide twice daily (BID) vs insulin glargine once daily (QD) as add-on therapy in Chinese type 2 diabetes patients not well controlled by oral anti-diabetic (OAD) agents. METHODS: The Cardiff model was populated with data synthesized from three head-to-head randomized clinical trials of up to 30 weeks in China comparing exenatide BID vs insulin glargine as add-on therapies to oral therapies in the Chinese population. The Cardiff model generated outputs including macrovascular and microvascular complications, diabetes-specific mortality, costs, and quality-adjusted life years (QALYs). Cost and QALYs were estimated with a time horizon of 40 years at a discount rate of 3% from a societal perspective. RESULTS: Compared with insulin glargine plus OAD treatments, patients on exenatide BID plus OAD gained 1.88 QALYs, at an incremental cost saving of Chinese Renminbi (RMB) 114,593 (i.e., cost saving of RMB 61078/QALY). The cost-effectiveness results were robust to various sensitivity analyses including probabilistic sensitivity analysis. The variables with the most impact on incremental cost-effectiveness ratio included HbA1c level at baseline, health utilities decrement, and BMI at baseline. CONCLUSIONS: Compared with insulin glargine QD, exenatide BID as add-on therapy to OAD is a cost-effective treatment in Chinese patients inadequately controlled by OAD treatments.
OBJECTIVE: To estimate cost-effectiveness of exenatide twice daily (BID) vs insulinglargine once daily (QD) as add-on therapy in Chinese type 2 diabetespatients not well controlled by oral anti-diabetic (OAD) agents. METHODS: The Cardiff model was populated with data synthesized from three head-to-head randomized clinical trials of up to 30 weeks in China comparing exenatideBID vs insulinglargine as add-on therapies to oral therapies in the Chinese population. The Cardiff model generated outputs including macrovascular and microvascular complications, diabetes-specific mortality, costs, and quality-adjusted life years (QALYs). Cost and QALYs were estimated with a time horizon of 40 years at a discount rate of 3% from a societal perspective. RESULTS: Compared with insulin glargine plus OAD treatments, patients on exenatideBID plus OAD gained 1.88 QALYs, at an incremental cost saving of Chinese Renminbi (RMB) 114,593 (i.e., cost saving of RMB 61078/QALY). The cost-effectiveness results were robust to various sensitivity analyses including probabilistic sensitivity analysis. The variables with the most impact on incremental cost-effectiveness ratio included HbA1c level at baseline, health utilities decrement, and BMI at baseline. CONCLUSIONS: Compared with insulin glargine QD, exenatideBID as add-on therapy to OAD is a cost-effective treatment in Chinese patients inadequately controlled by OAD treatments.
Authors: Bhavani Shankara Bagepally; Usa Chaikledkaew; Yogesh Krishnarao Gurav; Thunyarat Anothaisintawee; Sitaporn Youngkong; Nathorn Chaiyakunapruk; Mark McEvoy; John Attia; Ammarin Thakkinstian Journal: BMJ Open Diabetes Res Care Date: 2020-07