Abstract:
OBJECTIVE:Newer medications offer more options for glycemic control in type 2 diabetes. However, they come at considerable costs. We undertook a health economic analysis to better understand the value of adding two newer medications (exenatide and sitagliptin) as second-line therapy to glycemic control strategies for patients with new-onset diabetes. RESEARCH DESIGN AND METHODS:We performed a cost-effectiveness analysis for the U.S. population aged 25-64. A lifetime analytic horizon and health care system perspective were used. Costs and quality-adjusted life years (QALYs) were discounted at 3% annually, and costs are presented in 2008 U.S. dollars. We compared three glycemic control strategies: 1) glyburide as a second-line agent, 2) exenatide as a second-line agent, and 3) sitagliptin as a second-line agent. Outcome measures included QALYs gained, incremental costs, and the incremental cost-effectiveness ratio associated with each strategy. RESULTS:Exenatide and sitagliptin conferred 0.09 and 0.12 additional QALYs, respectively, relative to glyburide as second-line therapy. In base case analysis, exenatide was dominated (cost more and provided fewer QALYs than the next most expensive option), and sitagliptin was associated with an incremental cost-effectiveness ratio of 169,572 dollars per QALY saved. Results were sensitive to assumptions regarding medication costs, side effect duration, and side effect-associated disutilities. CONCLUSIONS:Exenatide and sitagliptin may confer substantial costs to health care systems. Demonstrated gains in quality and/or quantity of life are necessary for these agents to provide economic value to patients and health care systems.
journal_name
Diabetes Carejournal_title
Diabetes careauthors
Sinha A,Rajan M,Hoerger T,Pogach Ldoi
10.2337/dc09-1488subject
Has Abstractpub_date
2010-04-01 00:00:00pages
695-700issue
4eissn
0149-5992issn
1935-5548pii
dc09-1488journal_volume
33pub_type
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