Clinical benefits of dipeptidyl peptidase-4 inhibitors (DPP-4i) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) combination therapy have been demonstrated through clinical trials; however, there is limited understanding of economic benefits of sequential use of these therapies. This study evaluated the long-term cost-effectiveness of a treatment strategy involving intensification with SGLT2is (pathway 1) compared to NPH insulin (pathway 2) in type 2 diabetes (T2D) patients not at goal on metformin and sitagliptin therapy in the UK. The QuintilesIMS CORE Diabetes Model was used to perform cost-effectiveness analysis over a patient’s lifetime. Treatment effect data were obtained from randomized clinical trials, and economic data were obtained from multiple published sources. Several scenario analyses were performed to assess the robustness of base case results. Pathway 1 increased total life years (13.49 vs. 13.37, respectively) and quality-adjusted life years (QALY) (9.40 and 9.22, respectively) compared to pathway 2. Although drug costs in pathway 1 were higher than pathway 2, they were offset by decreases in diabetes-related complications and body mass index, leading to lower total direct medical costs for pathway 1 (£25,747 vs. £26,095). Thus, pathway 1 dominates pathway 2, as it is both more effective and less costly. Results from scenario analyses assessing changes in treatment effect, hypoglycemia rate, body mass index, cardiovascular protective effect of SGLT2i consistently showed that pathway 1 was either dominant (incremental cost effectiveness ratio (ICER) <$0/QALY) or cost-effective [(ICER < £3,000/QALY for patients with lower baseline HbA1c (7%) or older age (65+years)]. Among patients not at goal on metformin and sitagliptin therapy, treatment intensification with SGLT2i is likely to be cost effective compared to intensification with NPH insulin as 3rd line therapy in T2D in the UK.

Disclosure

M. Pawaskar: Employee; Self; Merck & Co., Inc. S. Bilir: Consultant; Self; Merck & Co., Inc.. A. Graber-Naidich: None. C.D. Gonzalez: Employee; Self; Merck & Co., Inc. S. Rajpathak: Employee; Self; Merck & Co., Inc. G.M. Davies: Employee; Self; Merck & Co., Inc..

© 2018 by the American Diabetes Association.
2018
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