Background and Aims: Metformin (met) plus [dipeptidyl peptidase-4 inhibitors (DPP-4i), is a commonly used dual therapy among type 2 diabetes (T2D) patients while drug classes such as glucagon-like peptide 1 receptor agonists (GLP-1)] and sodium-glucose co-transporter 2 inhibitors (SGLT2i) are often used as third line agents. We evaluated the long-term cost-effectiveness of a treatment pathway that included 3rd line met+DPP-4i+SGLT2i therapy (pathway 1) vs. switch to met +GLP-1 (pathway 2) in T2D patients not at goal on met+DPP-4i.

Materials and Methods: The validated IQVIA CORE Diabetes Model was used to perform cost-effectiveness analysis over a lifetime for a cohort of T2D patients in the U.S. Treatment effect data were obtained from randomized clinical trials and economic data were obtained from multiple published sources. Several scenario analyses including changes in clinical parameters were performed to assess the robustness of base case results.

Results: Pathway 1 with met+DPP-4i+SGLT2i tripe therapy resulted in increased total life years (Δ=0.049) and quality-adjusted life years (QALY) (Δ=0.026) vs. to pathway 2 (i.e., switching to met+GLP-1). Total medical costs (including drug costs, cost of complications and adverse events (Δ =-$9,511) were lower for patients in pathway 1 vs. pathway 2. Pathway 1 dominates pathway 2, as it is more effective (measured in terms of QALYs) and less costly. Scenario analyses results assessing changes in treatment effect, body mass index, adverse event profiles and different drug cost estimates consistently showed that pathway 1 was either dominant or cost-effective (Incremental cost effectiveness ratio = $76,000/QALY for the most conservative drug costs assumption for DPP-4i plus SGLT2i).

Conclusion: Among patients not at goal on met&ormin and DPP-4i therapy in the U.S., triple therapy wit& met+DPP-4i+SGLT2i was likely to be a cost-effective alternative compared to switching to met+GLP-1.


M. Pawaskar: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. S. Bilir: Employee; Self; IQVIA. G.M. Davies: Employee; Self; Merck & Co., Inc.

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