Cost-Effectiveness of Dapagliflozin Versus Acarbose as A Monotherapy in Type 2 Diabetes in China

Abstract

ObjectiveTo estimate the long-term cost-effectiveness of dapagliflozin versus acarbose as monotherapy in treatment-naïve patients with type 2 diabetes mellitus (T2DM) in China. MethodsThe Cardiff Diabetes Model, an economic model designed to evaluate the cost-effectiveness of comparator therapies in diabetes was used to simulate disease progression and estimate the long-term effect of treatments on patients. Systematic literature reviews, hospital surveys, meta-analysis and indirect treatment comparison were conducted to obtain model-required patient profiles, clinical data and costs. Health insurance costs (2015¥) were estimated over 40 years from a healthcare payer perspective. Univariate and probabilistic sensitivity analyses were performed. ResultsThe model predicted that dapagliflozin had lower incidences of cardiovascular events, hypoglycemia and mortality events, was associated with a mean incremental benefit of 0.25 quality-adjusted life-years (QALYs) and with a lower cost of ¥8,439 compared with acarbose. This resulted in a cost saving of ¥33,786 per QALY gained with dapagliflozin. Sensitivity analyses determined that the results are robust. ConclusionDapagliflozin is dominant compared with acarbose as monotherapy for Chinese T2DM patients, with a little QALY gain and lower costs. Dapagliflozin offers a well-tolerated and cost-effective alternative medication for treatment-naive patients in China, and may have a direct impact in reducing the disease burden of T2DM.

Economic evaluation of dapagliflozin versus metformin in Chinese patients whose diabetes is inadequately controlled with diet and exercise

“…Previous studies have indicated that, in T2DM patients who were no longer responsive to diet and exercise, the dapagliflozin monotherapy was dominant compared with glimepiride and acarbose in the Chinese setting. Both of them indicated that weight control was the most influential factor affecting the economic outcome [8,9].…”

“…The annually costs of medicine and glucose testing strips were estimated from a large national population-based screening study [26], which interviewed 1482 adults with diabetes at 12 sites in China. Apart from the treatment cost of hyperglycemia, other potential direct health resource utilization, such as the costs of hospitalization and outpatient visits due to their developed complications, also reflected in the simulation, which was extracted directly from published literature or other local sources [4,8,9,[27][28][29]. The cost related to hypoglycemia were estimated from the patient records of two hospitals (Yueyang and Ren JiHospital) in 2016, including 172 patients diagnosed with hypoglycemia who visited the emergency clinic.…”

“…In China, dapagliflozin has not been reimbursed. The recent two economic reports have suggested the dapagliflozin might be a cost-effective alternative compared with acarbose and glimepiride as monotherapy in drug-naive Chinese T2DM patients [8,9]. However, both of them did not consider the metformin as a baseline comparator, which was recommended as the initial monotherapy for newly diagnosed T2DM by the latest Chinese guideline [10].…”

Cost‐effectiveness of exenatide twice daily vs insulin glargine as add‐on therapy to oral antidiabetic agents in patients with type 2 diabetes in China

“…The model uses the 68 or 82 risk equations from the UK Prospective Diabetes Study (UKPDS) to estimate the risk of clinical endpoints and predict the occurrence of diabetes‐related complications and mortality . The present study used the UKPDS 68‐equation model as these equations are widely implemented in diabetes modelling and are extensively tested and validated compared with the UKPDS 82 equations . A sensitivity analysis was performed using the latter model.…”

The Cost-Effectiveness of Lifestyle Interventions for Preventing Diabetes in a Health Resource-Limited Setting

“…The annual costs of medicine and glucose testing strips were originated from a large scale population-based study [27]. The costs of inpatient and outpatient visits due to vascular complications were extracted directly from publications [4,[28][29][30][31][32]. The expense of severe hypoglycemic events was derived from a Chinese costing study, which included 275 patients who incurred hypoglycemic episode [33].…”