Introduction: There are multiple antidiabetic drugs for type 2 diabetes in China, which vary in efficacy and cost. Chinese guideline recommends a stepwise escalation treatment strategy in diabetes care which consists of 3 therapy lines; and using combination therapy of antidiabetic drug + metformin (MET) for patients failed on MET. This study aims to develop 10 alternative drug combination strategies and compare their cost-effectiveness.
Method: Based on Chinese guideline, 8 classes of antidiabetic drugs were included: 1st line drug (MET), 2nd line drug (α glycosidase inhibitor=AGI, sulfonylurea=SU, glinide=NIDE, DPP-4 inhibitor=DPP-4I, thiazolidinedione=TZD), 3rd line drug (insulin=INS, GLP-1 receptor agonist=GLP-1RA); 10 drug combination strategies were developed: use MET as 1st therapy line, one of the five 2nd line drug + MET as 2nd therapy line, one of the two 3rd line drug + MET as 3rd therapy line. From societal perspective, Cardiff model was used to estimate cost-effectiveness of 10 drug combination strategies vs. non-drug treatment. Clinical data on Chinese patients were obtained from systematic literature review and meta-analysis of 325 studies. Costs were obtained from claims database study of 1164 patients. Utilities were obtained from EQ-5D survey of 868 patients. Simulation was 40 years. Discount rate was 3%. Sensitivity analysis was performed.
Result: All drug combination strategies were cost saving (increase QALYs but save costs) vs. non-drug treatment. Ranking strategies by considering incremental QALY and cost, strategy 5b (MET, MET+NIDE, MET+INS) was optimal, followed by strategy 6b (MET, MET+NIDE, MET+GLP-1RA), strategy 3b (MET, MET+SU, MET+INS), strategy 1b (MET, MET+AGI, MET+INS), strategy 4b (MET, MET+SU, MET+GLP-1RA), strategy 2b (MET, MET+AGI, MET+GLP-1RA), strategy 7b (MET, MET+DPP-4I, MET+INS), strategy 10b (MET, MET+TZD, MET+GLP-1RA), strategy 8b (MET, MET+DPP-4I, MET+GLP-1RA), strategy 9b (MET, MET+TZD, MET+INS).
Conclusion: Strategy 5b is worthy of clinical use.
S. Gu: None. Y. Shen: None. L. Shi: None. H. Dong: None.