ObjectiveTo compare the safety and efficacy of the dipeptidylpeptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes and inadequate glycemic control.DesignSystematic review of randomized controlled trials (RCTs), health economic evaluation studies, systematic reviews, and meta-analyses, followed by primary Bayesian mixed treatment comparison meta-analyses (MTCs), and secondary frequentist direct-comparison meta-analyses using a random-effects model. Outcomes were reported as weighted mean change from baseline, or odds ratio (OR) with 95% credible interval.Data sourcesMEDLINE, MEDLINE In-Process, EMBASE, and BIOSIS via Dialog ProQuest; Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews via EBSCO; four diabetes and two technical congress abstracts; and health technology assessment organization websites.Eligibility criteriaPatients with type 2 diabetes and inadequate glycemic control receiving any pharmacological anti-diabetic treatment.Data extraction and analysisTitle/abstracts were reviewed for eligibility, followed by full-text review of publications remaining after first pass. A three-person team filtered articles and an independent reviewer checked a random selection (10%) of filtered articles. Data extraction and quality assessment of studies were also independently reviewed. Five DPP-4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin, and vildagliptin) were compared via meta-analysis (where data were available) as monotherapy, dual therapy (plus metformin, sulfonylurea, pioglitazone, or insulin), and triple therapy (plus metformin/sulfonylurea).ResultsThe review identified 6,601 articles; 163 met inclusion criteria and 85 publications from 83 RCTs contained sufficient or appropriate data for analysis. MTCs demonstrated no differences between DPP-4 inhibitors in mean change from baseline in glycosylated hemoglobin (HbA1c) or body weight, or the proportions of patients achieving HbA1c <7% or experiencing a hypoglycemic event, apart from in patients on alogliptin plus metformin, who achieved HbA1c <7% more frequently than those treated with saxagliptin plus metformin [OR 6.41 (95% CI 3.15–11.98) versus 2.17 (95% CI 1.56–2.95)].ConclusionsThis systematic review and MTC showed similar efficacy and safety for DPP-4 inhibitors as treatment for type 2 diabetes, either as monotherapy or combination therapy.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-014-0061-3) contains supplementary material, which is available to authorized users.

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docetaxel as second-line treatment in non-small cell lung cancer (NSCLC) patients who were previously treated with platinum-containing chemotherapy from the United States societal perspective. MethodS: A Markov model with three health states was developed using the literature-based data for transition probabilities, costs, and health utilities. The model estimated incremental cost-effectiveness ratio (ICER) and net monetary benefits (NMB) for each of three study drugs compared with docetaxel. One-way and probabilistic sensitivity analyses concerning key parameters were conducted to test the robustness of the results.

is an equally efficacious alternative to urinary derived FSH, Menopur®. One differences between these products is their delivery devices; Gonal f® is provided as a multidose pen, Menopur® in vials or multidose preparation, and Bemfola® as a fixed dose pen. The aim of this study was to determine the impact of delivery device on drug wastage and associated cost. Methods: A retrospective analysis of Gonal-f® and Menopur® prescription and usage data from five UK infertility clinics was conducted to identify the level of wastage occurring from IVF cycles. Data collected included: number IVF cycles conducted in previous 12 months; daily dose; length of treatment; dose adjustment following ultrasound scan and FSH formulation(s) prescribed. The drug wastage for each patient was calculated and results compared to the potential Bemfola® wastage for these patients. The wastage cost was then determined using NHS list prices. Results: A total of 4724 IVF cycles were incorporated into the analysis. Of the 4078 Gonal-f® cycles, overall drug wastage was 650,775IU (5.7% of total dose prescribed) equating to 160IU per patient. For the 646 Menopur® cycles the wastage was 190,163IU (11.6% of total dose prescribed) equating to 294IU per patient. Had Bemfola® been used in these patients, the wastage would have been reduced to 104IU and 61IU per patient respectively. The use of Bemfola®, across all cycles, results in a drug wastage reduction of 376,800IUs and an associated cost saving of £100,011. Extrapolating this data to the annual number of UK IVF cycles results in a potential cost saving of £1,157,579. ConClusions: Using Bemfola® as an alternative to Gonal-f® or Menopur® can potentially reduce drug wastage and associated costs to both patients and the NHS.