Cost Effectiveness Evaluation of Canagliflozin In Combination With Metformin in the Treatment Of Type 2 Diabetes Mellitus In Poland

Abstract

Objectives: To evaluate the cost-effectiveness of canagliflozin, an active inhibitor of sodium glucose co-transporter -2 (SGLT2) in dual therapy as add-on to metformin compared to sitagliptin and glimepiride. Canagliflozin in clinical trial results showed effective glucose reduction, along with other benefits in diabetes treatment including weight loss and SBP reduction. Cost effectiveness analyses were conducted in the Polish setting from a public perspective in accordance with guidelines of Polish HTA Agency (PolAHTA). MethOds: The IMS CORE Diabetes Model was used to evaluate the cost-effectiveness of canagliflozin versus the aforementioned comparators using Polish-specific data, where available. Direct costs were reported in Polish zloty and an annual discount rate of 5% and 3.5% were applied on costs and effects respectively. Results: In dual therapy as add-on to metformin, canagliflozin 100 mg dominates sitagliptin with average cost savings of 2 811 zł and an average QALY gain of 0.06, canagliflozin 300 mg is cost effective option in comparison to sitagliptin with an incremental cost effectiveness ratio (ICER) of 45 008 zł per QALY and QALY gain of 0.09. As add-on to metformin canagliflozin is a cost effectiveness option in comparison with glimepiride with ICER of 28 454 zł and 73 102 zł, QALY gain 0,112 QALY and 0,140 QALY for canagliflozin 100 mg and 300 mg respectively. All results are below defined in Polish reimbursement act cost-effectiveness threshold. cOnclusiOns: These results suggest that adding Canagliflozin to metformin versus sitagliptin or glimepiride in patients inadequately controlled with metformin would be a more efficient use of health care resources in the Polish setting.Objectives: To evaluate the cost-effectiveness of interventions aimed at decreasing the number of amputations among patients with diabetic foot ulcers (DFU) in Russia. MethOds: We have modeled the changes in the annual outcomes (minor and major amputations) and costs (services provided in outpatient clinics and hospitals, medications, orthopedic shoes and prosthetic devices and services provided in case of amputation) from the perspective of public health and social care. Two interventions were assessed: preventive services for patients with the very high risk of DFU (additional outpatient visits for foot care and orthopedic shoes) and provision of care for DFU patients at hospital by multidisciplinary foot care team (MDT). The current number of amputations and costs among DFU patients in Russia was assessed on the basis of published Russian data and experts' survey. The expected effectiveness of interventions was derived from the international publications. Costs were estimated on the basis on reimbursement rates in public medical insurance and social care. Results: The implementation of hospital care by MDT for cohort of 1000 DFU patients at the current rate of hospitalizations will require additional annual spending of € 532,520, and the expected annual number of major amputations will decrease by 41. The ICER for this...

Canagliflozin in the treatment of type 2 diabetes: an evidence-based review of its place in therapy

“…This was also the case for canagliflozin 100 mg, based on economic evaluations in Spain56 and Poland,57 whereas canagliflozin 300 mg produced an ICER of €181356 and 45,008 zł57 compared with sitagliptin, respectively. Results from additional country-specific analyses versus sitagliptin also suggest that canagliflozin is likely to be a cost-effective option adjunct to metformin, in Ireland,58 France,59 Belgium,60 Slovakia,61 and the Czech Republic 62.…”

“…As add-on to metformin, canagliflozin, assessed as a weighted average of 100 and 300 mg, dominated sitagliptin 100 mg in cost-effectiveness analyses conducted in the Swedish, 53 Norwegian, 54 and Portuguese 55 setting. This was also the case for canagliflozin 100 mg, based on economic evaluations in Spain 56 and Poland, 57 whereas canagliflozin 300 mg produced an ICER of €1813 56 and 45,008 zł 57 compared with sitagliptin, respectively. Results from additional country-specific analyses versus sitagliptin also suggest that canagliflozin is likely to be a cost-effective option adjunct to metformin, in Ireland, 58 France, 59 Belgium, 60 Slovakia, 61 and the Czech Republic.…”

“…Evidence from economic evaluations across different health care systems, including Sweden, Norway, Poland, Belgium, Ireland, and the Czech Republic, suggest that canagliflozin as add-on to metformin is cost-effective, compared with sulfonylureas 53,54,57,60,62,64. In a similar manner, dapagliflozin 10 mg was also dominated by canagliflozin in two economic evaluations in the USA and Spain, utilizing the Economic and Health Outcomes Model for type 2 diabetes mellitus (ECHO-T2DM)65 and the IMS Core Diabetes Model66, respectively.…”