BackgroundType 2 diabetes mellitus (T2DM) is a chronic metabolic disease with substantial morbidity, mortality, and economic impacts. Glucagon-like peptide-1 (GLP-1) receptor agonists, such as once-daily (QD) liraglutide and once-weekly (QW) exenatide, are FDA-approved treatment for T2DM. Head-to-head trials and meta-analyses comparing these agents have reported clinically meaningful improvements but small differences in glycemic control between both agents. In this study, we calculate and compare the cost-effectiveness implications of these alternative effectiveness outcomes.MethodsWe developed a decision model to evaluate the short-term cost-effectiveness of exenatide QW 2 mg versus liraglutide QD 1.8 mg in T2DM patients, with effectiveness measured as reduction in glycated hemoglobin (HbA1c). In the base case, the model tracks change in HbA1c and direct medical expenditure over a 6-month time horizon. We calculated and compared the cost per 1% reduction in HbA1c of models populated with clinical data from a head-to-head randomized, controlled trial (DURATION-6) and a network meta-analysis. Expenditure inputs were derived from wholesale acquisition costs and published sources.ResultsIn the base case, 6-month expenditure for the liraglutide and exenatide strategies were $3,509 and $2,618, respectively. Using clinical data from DURATION-6 and the network meta-analysis, the liraglutide strategy had an incremental cost per 1% reduction in HbA1c of $4,773 and $27,179, respectively. The most influential model parameters were drug costs, magnitude of HbA1c reduction in patients on treatment for >1 month, and liraglutide gastrointestinal adverse event rate. In probabilistic sensitivity analyses (PSA) using DURATION-6 data, the exenatide strategy was optimal at willingness-to-pay levels below $4,800 per 1% reduction in HbA1c. In a PSA using meta-analysis data, the exenatide strategy was dominant.ConclusionsOur modeled results demonstrate that the effectiveness and cost-effectiveness of liraglutide QD 1.8 mg relative to exenatide QW 2 mg depend largely on the chosen source of the clinical data.

cross-sectional survey was conducted among total of 350 diabetic patients randomly selected including 175 each from private and public hospitals. The study was conducted from May to July 2012 including patients of having at least a year of illness and of 30 to 65 years of age. Results: The mean total cost per visit by a diabetic patient to a private hospital was US $14.3 (95% CI: 12.70 -16.92) as compared to US $ 10.31(95% CI: 9.88-12.36) for public hospital. Similarly, total direct cost for the treatment and care of patients per month was US$ 58.10 (95% CI: 41.33-62.12) in private hospital in comparison to US $ 33.22 (95% CI: 27.32-36.88) for those attending public hospitals. The per capita is just US$ 742. ConClusions: The study concludes that there was high economic burden on the patients with diabetes getting care from private sector as compared to public hospitals.

different treatment regimens in Hepatitis C patients using discrete choice experiment(DCE), so as to provide reference for improving the participation of patients in decision-making. Methods: Eight attributes related to Hepatitis C were determined by literature review and pre-survey. The probability of occurrence and severity were considered at the same time for the side effects. The orthogonal experimental design was used to generate 32 combinations to form DCE questionnaire. The survey was conducted in Tianjin in December 2018. Effects coding and random parameter logit model was used for data analysis. Results: A total of 111 patients completed the questionnaire, of which 36.04% were male. The preference weight for different attributes was ranked as following: sustained virological response(SVR), nausea/ vomiting, rash, insomnia, number of interferon injections, weeks of treatment, tiredness/fatigue and the relative weight was 10.00, 2.12, 1.32, 0.69, 0.32, 0.23 and 0.17, respectively. In terms of willingness payment, patients are willing to pay RMB 33,873 per course of treatment to achieve the highest SVR. Conclusions: From the perspective of patients, efficacy is the most essential criterion to be considered. Side effects and modes of administration also play a certain role in the treatment choice of patients. Furthermore, patients have different evaluations on the probability and severity for the same side effects.

A45some point during the course of the disease. Within the latter group, stenosis was found to be the diagnosis associated with the highest total costs. ConClusions: The treatment pathway for low back pain has not been modelled in such a comprehensive manner before. However, the model demands detailed data not currently available in most countries. There is a need of further data collection to be able to provide more reliable estimates for the burden of spinal disease.

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