A systematic review of economic evaluations in non-insulin antidiabetic treatments for patients with type 2 diabetes mellitus

Abstract

The approval of new non-insulin treatments has broadened the therapeutic arsenal, but it has also increased the complexity of choice for the treatment of type 2 diabetes mellitus (DM2). The objective of this study was to systematically review the literature on economic evaluations associated with non-insulin antidiabetic drugs (NIADs) for DM2. We searched in Medline, IBECS, Doyma and SciELO databases for full economic evaluations of NIADs in adults with DM2 applied after the failure of the first line of pharmacological treatment, published between 2010 and 2017, focusing on studies that incorporated quality-adjusted life years (QALYs). The review included a total of 57 studies, in which 134 comparisons were made between NIADs. Under an acceptability threshold of 25,000 euros per QALY gained, iSLGT-2 were preferable to iDPP-4 and sulfonylureas in terms of incremental cost-utility. By contrast, there were no conclusive comparative results for the other two new NIAD groups (GLP-1 and iDPP-4). The heterogeneity of the studies’ methodologies and results hindered our ability to determine under what specific clinical assumptions some NIADs would be more cost-effective than others. Economic evaluations of healthcare should be used as part of the decision-making process, so multifactorial therapeutic management strategies should be established based on the patients’ clinical characteristics and preferences as principal criteria.

Swiss recommendations of the Society for Endocrinology and Diabetes (SGED/SSED) for the treatment of type 2 diabetes mellitus (2023)

“…Similarly, add-on therapy of GLP1 receptor agonists to metformin was found to be cost-effective compared to insulin or DPP-4i therapy [55,58]. In addition, diabetes model-based simulations showed that GLP1 receptor agonists might be cost-effective in patients with or at high cardiovascular risk compared to the standard care [59,60].…”

“…As first-line agents, SGLT-2 inhibitors and GLP-1 receptor agonists would improve type 2 diabetes outcomes, but they are probably not cost-effective compared to metformin due to their high medication costs [54]. However, several studies showed that SGLT-2 inhibitors and GLP-1 receptor agonists as an add-on therapy to metformin are cost-effective and maybe cost-saving compared to other antidiabetic drugs [55]. In particular, in combination with metformin, SGLT-2 inhibitor treatment is cost-effective or even costsaving compared to DPP-4i, sulfonylurea, or glitazone medication [55].…”

“…However, several studies showed that SGLT-2 inhibitors and GLP-1 receptor agonists as an add-on therapy to metformin are cost-effective and maybe cost-saving compared to other antidiabetic drugs [55]. In particular, in combination with metformin, SGLT-2 inhibitor treatment is cost-effective or even costsaving compared to DPP-4i, sulfonylurea, or glitazone medication [55]. Using diabetes model-based simulations, SGLT2i is a cost-saving treatment in patients with chronic kidney disease and a cost-effective treatment in patients with HFrEF compared to the standard of care [56,57].…”

Diabetes Patients’ Acceptance of Injectable Treatment, a Scientometric Analysis

“…Non-adherence to treatment is due to forgetting the daily injections, especially when more doses are needed, and the short duration of the disease [39]. (9) The administration of various new antidiabetic therapies (DPP4, SGLT2 inhibitors) shall be conducted with caution and not on a large scale, due to the short-and long-term effectiveness uncertainty and due to possibly severe side effects [40].…”

Changes in glycaemic control of oral anti-diabetic medications assessed by continuous glucose monitors among patients with type 2 diabetes: a protocol of network meta-analysis

“…Existing guidelines and evidence recommend metformin as first-line treatment, sulfonylurea as second-line treatment (or first-line treatment if metformin is contraindicated) and insulin as third-line treatment [ 3 – 5 ]. Increasing evidence have suggested that anti-diabetic medications (ADMs) reduce the incidence of long-term complications, hospital admission, and mortality among patients with diabetes [ 6 ].…”