Cost‐effectiveness of sodium‐glucose cotransporter‐2 inhibitors versus dipeptidyl peptidase‐4 inhibitors among patients with type 2 diabetes with and without established cardiovascular diseases: A model‐based simulation analysis using 10‐year real‐world data and targeted literature review

Abstract

Aim: We conducted a model-based economic analysis of sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus dipeptidyl peptidase-4 inhibitors (DPP4is) in patients with type 2 diabetes (T2D), with and without established cardiovascular diseases (CVDs), using 10-year real-world data. Materials and Methods:A Markov model was utilized to estimate healthcare costs and quality-adjusted life-years (QALYs) over a 10-year simulation time horizon from a healthcare sector perspective, with both costs and QALYs discounted at 3% annually. Model inputs were derived from analyses of Taiwan's National Health Insurance Research Database or published studies of Taiwanese populations. The primary outcome measure was the incremental cost-effectiveness ratios (ICERs). Incorporated with our study findings, a targeted literature review was conducted to synthesize updated evidence on the cost-effectiveness of SGLT2is versus DPP4is.

A Systematic Review of Cost-Effectiveness Studies of Newer Non-Insulin Antidiabetic Drugs: Trends in Decision-Analytical Models for Modelling of Type 2 Diabetes Mellitus

“…The results of extracted data from included studies can be found in Table 1, which summarises the general characteristics of the studies. The majority of studies (n = 30) were conducted in Europe , of which many were conducted in the UK (n = 9) [37,38,40,45,46,48,51,57,62], and one-third of the studies were conducted in North America (n = 10) [64][65][66][67][68][69][70][71][72][73] and Asia (n = 8) [74][75][76][77][78][79][80][81]. Two studies were conducted outside these regions: one each from Colombia [82] and Iran [83].…”

“…One study used both the IHE-DCM and the ECHO-T2DM to produce and compare their results [73]. Eight studies did not state the model name, of which three studies [71,80,83] used Markov state transition models, three used individual patient simulations [55,67,72], and one each used a state transition cohort model with a competing risk approach [70] and a decision tree [65].…”

“…The majority of studies conducted analyses using the payer's perspective (n = 31) [34, 36-42, 45-52, 55, 57, 59, 61-67, 69, 70, 72, 75, 77]. Less frequently, a healthcare sector perspective (n = 10) [56,58,59,71,74,76,[78][79][80][81] and a societal perspective were used in six studies [35,43,44,53,54,68]. Two studies used both a payer's perspective and a societal perspective [60,73], while the perspective employed by one study was unclear [82].…”

“…The majority had a time horizon of either 40 years (n = 12) [34-36, 44, 50, 54, 60, 68, 73, 75, 79, 81] or 50 years (n = 21) [37-42, 45-49, 51, 52, 56, 58, 59, 61-63, 76, 77], while some studies (n = 11) reported a lifetime horizon [43,53,55,57,64,67,69,70,72,74,78]. The remainder had a time horizon of 30 years [66] or 10 years [80,83].…”

“…Sometimes the background medication was described as 'Standard of Care' (SoC) or '1-2 oral antidiabetic drugs'. Two studies had unclear reporting on the background medication [71,80]. With regard to combination therapy, most studies (n = 22) involved dual or triple therapy, while some studies (n = 19) had dual therapy and the remaining eight studies had triple therapy or above [36,54,59,69,72,75,76,83].…”