Cost-Effectiveness of Interventions Aimed at Decreasing The Number of Amputations Among Patients With Diabetes Mellitus

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...

Effectiveness of multidisciplinary care teams in reducing major amputation rate in adults with diabetes: A systematic review & meta-analysis

“…There still lies a question regarding the cost-effectiveness of multidisciplinary care teams and prevention programs for adults with diabetes. Ignatyeva et al [24] conducted a costeffectiveness analysis on two interventions for reducing the rate of amputation in a high risk diabetic population in Russia. The authors assessed results from a preventive care service providing shoes and orthotics to high risk patients versus a multidisciplinary group in a hospital setting.…”

Challenges of providing specialized outpatient care for patients with diabetes mellitus and lower extremity involvement

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