Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system

Nita, Marcelo Eidi; Eliaschewitz, Freddy Goldberg; Ribeiro, Eliane; Asano, E.; Barbosa, Elias; Takemoto, Maíra Libertad Soligo; Donato, B.M.K.; Rached, R; Rahal, Elaine

doi:10.1016/s0104-4230(12)70198-7

Cited by 11 publications

(25 citation statements)

References 34 publications

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“…In all comparisons, the authors considered saxagliptin was cost-saving when combined with metformin versus the glitazone combinations. However, they did not research saxagliptin as monotherapy [50]. In a recent systematic review summarizing the results of the cost-effectiveness assessments of gliptins either as monotherapy or in combination, the authors concluded that gliptins combined with metformin are a cost-effective option compared to sulfonylureas and insulin.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of vildagliptin for people with type 2 diabetes mellitus in Brazil; findings and implications

Oliveira

Júnior

Godman

et al. 2017

Expert Review of Pharmacoeconomics & Outcomes Research

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Vildagliptin is an inhibitor of the enzyme dipeptidyl peptidase 4, indicated for the treatment of type 2 diabetes mellitus, combined or not with metformin. This study aims to evaluate the cost-effectiveness of vildagliptin in the Brazilian context. Areas covered: Using MEDLINE, Cochrane Library, Lilacs and CRD, six studies were selected for the economic models. This study utilised cost data in the Brazilian health system to provide the context. Expert commentary: Type 2 diabetes mellitus is an epidemic disease and represents a challenge for all health care systems. Although guidelines clearly define first-line treatment, there are several other promising treatments. Vildagliptin is one of them, resulting in a mean lifetime increase of 0.31 years compared to metformin alone and 1.19 more life years compared to other metformin combinations. Considering observational data, life years with dual vildagliptin-containing treatments were 0.37 more compared to other dual treatments. However, its high cost versus generic metformin and its unclear safety profile weakens its subsequent cost-effectiveness. Consequently, the incorporation of vildagliptin or its combination with metformin is currently not recommended for the Brazilian Health Care System. This may change as more data becomes available.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of vildagliptin for people with type 2 diabetes mellitus in Brazil; findings and implications

Oliveira

Júnior

Godman

et al. 2017

Expert Review of Pharmacoeconomics & Outcomes Research

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“…At least one type of scenario comparison was reported by 83 of the studies (90%) [12][13][14][15][16][17][65][66][67][68][69][70][71]73,[75][76][77][78][79][80][81][82][83][84][85][89][90][91][92][93][94][95][96][97][98]100,102,103]. Bearing in mind that the same study may have made more than one assessment: comparisons involved costs comprised 33%, epidemiologic data 17%, the use of different medicines 16%, and market share 15%.…”

Section: Scenario Analysismentioning

confidence: 99%

Budget impact analysis of medicines: updated systematic review and implications

Faleiros

Álvares

Almeida

et al. 2016

Expert Review of Pharmacoeconomics & Outcomes Research

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This evaluation determines whether published studies to date meet the key characteristics identified for budget impact analyses (BIA) for medicines, accomplished through a systematic review and assessment against identified key characteristics. Studies from 2001-2015 on 'budget impact analysis' with 'drug' interventions were assessed, selected based on their titles/abstracts and full texts, and their characteristics checked according to key criteria. Out of 1,984 studies, 92 were subsequently identified for review. Of these, 95% were published in Europe and the USA. 2012 saw the largest number of publications (16%) with a decline thereafter. 48% met up to 7 out of the 9 key characteristics. Only 22% stated no conflict of interest. The results indicate low adherence to the key characteristics that should be considered for BIAs and strong conflict of interest. This is an issue since BIAs can be of fundamental importance in managing the entry of new medicines including reimbursement decisions.

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“…In fact, few Brazilian studies have been published on health economics, 5,7,28,36,40 and none of them related to spine care in neurosurgery or orthopedics. Some countries have established that thresholds of what should be cost-effective: $50,000.00-$100,000.00 per QALY in the US, 41 Can$20,000.00-$40,000.00 in Canada, 23 and £20,000.00-£30,000.00 in the United Kingdom.…”

Section: Discussionmentioning

confidence: 99%

Economic value of treating lumbar disc herniation in Brazil

Falavigna

Scheverin²,

Righesso

et al. 2016

SPI

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OBJECT Lumbar discectomy is one of the most common surgical spine procedures. In order to understand the value of this surgical care, it is important to understand the costs to the health care system and patient for good results. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life year (QALY) gained for patients in Brazil. METHODS The authors performed a prospective cohort study involving 143 consecutive patients who underwent open discectomy for lumbar disc herniation (LDH). Patient-reported outcomes were assessed utilizing the SF-6D, which is derived from a 12-month variation of the SF-36. Direct medical costs included medical reimbursement, costs of hospital care, and overall resource consumption. Disability losses were considered indirect costs. A 4-year horizon with 3% discounting was applied to health-utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and US dollars ($), applying an exchange rate of 2.4:1 (the rate at the time of manuscript preparation). RESULTS The direct and indirect costs of open lumbar discectomy were estimated at an average of R$3426.72 ($1427.80) and R$2027.67 ($844.86), respectively. The mean total cost of treatment was estimated at R$5454.40 ($2272.66) (SD R$2709.17 [$1128.82]). The SF-6D utility gain was 0.044 (95% CI 0.03197–0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$30,828.35 ($12,845.14) per QALY gained. The sensitivity analysis showed a range of R$25,690.29 ($10,714.28) to R$38,535.44 ($16,056.43) per QALY gained. CONCLUSIONS The use of open lumbar discectomy to treat LDH is associated with a significant improvement in patient outcomes as measured by the SF-6D. Open lumbar discectomy performed in the Brazilian supplementary health care system provides a cost-utility ratio of R$30,828.35 ($12,845.14) per QALY. The value of acceptable cost-effectiveness will vary by country and region.

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Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system

Cited by 11 publications

References 34 publications

Cost-effectiveness of vildagliptin for people with type 2 diabetes mellitus in Brazil; findings and implications

Cost-effectiveness of vildagliptin for people with type 2 diabetes mellitus in Brazil; findings and implications

Budget impact analysis of medicines: updated systematic review and implications

Economic value of treating lumbar disc herniation in Brazil

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