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

Ni, Hua; Wang, Xu; Ma, Jing; Fei, Jie; Wu, Bin

doi:10.1186/s12962-020-00208-w

Cited by 11 publications

(14 citation statements)

References 39 publications

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“…Several CE studies have tested whether dapagliflozin could be cost-effective compared with other treatment strategies for diabetes patients in China, but their conclusions were not consistent. 10,11 However, there was no CE study for dapagliflozin in HFrEF patients. Given that the combination of dapagliflozin has potential for widespread use among HFrEF patients, decision makers must determine whether the extra benefit with dapagliflozin is worth the additional costs.…”

Section: Discussionmentioning

confidence: 99%

“…Cost‐effectiveness (CE) analysis (CEA) is a useful approach to assess medication value by quantifying and comparing the therapy cost and effectiveness of different treatment strategies. The CE of dapagliflozin (compared with different treatment strategies) for patients with type 2 diabetes mellitus was not consistent in China 10,11 . Additionally, there is no study about the CE of dapagliflozin among HFrEF patients in China.…”

Section: Introductionmentioning

confidence: 94%

“…The CE of dapagliflozin (compared with different treatment strategies) for patients with type 2 diabetes mellitus was not consistent in China. 10,11 Additionally, there is no study about the CE of dapagliflozin among HFrEF patients in China. With the goal of aiding decision making, we estimated the CE of adding dapagliflozin to standard treatment compared with not adding dapagliflozin for HFrEF patients in China's medical circumstance from a perspective of health care payers.…”

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness of adding dapagliflozin to standard treatment for heart failure with reduced ejection fraction patients in China

Yao

Zhang

et al. 2020

ESC Heart Failure

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Aims This study was to determine the cost-effectiveness of dapagliflozin in heart failure with reduced ejection fraction (HFrEF) patients in China from a perspective of health care payers. Methods and results We built a Markov model to perform a cost-effectiveness analysis comparing standard treatment + dapagliflozin (10 mg, q.d.) with standard treatment for HFrEF. The base case in our simulation was a 65-yearold HFrEF patient and was modelled over 15 years. Inputs of the model were derived from the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial and other relevant data from China. Costs, quality-adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER) were estimated for adding dapagliflozin relative to standard treatment. Costs and QALY were discounted at a 4.2% rate annually. All costs are presented in 2017 US dollars. Dapagliflozin would be considered very cost-effective if the ICER was lower than a willingness-to-pay (WTP) threshold of $8573.4. Uncertainty was assessed in our model using one-way, two-way, and probabilistic sensitivity analysis (PSA). In our base case, compared with standard treatment, adding dapagliflozin was more expensive ($5829.4 vs. $4377.1) but more effective (4.82 vs. 4.44 QALYs). The respondent ICER was $3827.6 per QALY gained at 15-year follow-up. When the simulated horizon was longer than 3.5 years, the respondent ICER became lower than the WTP threshold. The inputs with the largest impact on ICER were the cost of dapagliflozin, the cardiovascular mortality in both groups, and the cost of hospitalization for heart failure. Most results of sensitivity analysis were robust. PSA showed a similar result as the base case (ICER = $4412.5 per QALY gained). In Monte Carlo simulation, at a WTP threshold of $8573.4 per QALY, dapagliflozin was considered very cost-effective in 53.10% of the simulations. Conclusions Dapagliflozin was a very cost-effective treatment option for HFrEF patients in China according to the result of our model. Our findings will help doctors and health care payers to make decisions in clinical practice. Future real-world studies of cost-effectiveness of dapagliflozin based on Chinese population were also needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Cost‐effectiveness of adding dapagliflozin to standard treatment for heart failure with reduced ejection fraction patients in China

Yao

Zhang

et al. 2020

ESC Heart Failure

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“…The analysis was carried out by using a mathematical model, which could annually track the T2DM progression from prediabetes (Figure 1). Once the patients developed T2DM, the disease course would be projected by using the Chinese Outcomes Model for T2DM (COMT) [8,12,13]. This validated diabetes policy analysis model would track simultaneously several critical diabetic macro-and microvascular complications for one hypothetical T2DM patient, including myocardial infarction (MI), congestive heart failure (CHF), cardiovascular disease (CVD), stroke, blindness, end-stage renal disease (ESRD), clinical neuropathy, foot ulcer, and minor and major amputation.…”

Section: Methodsmentioning

confidence: 99%

“…Lifestyle intervention has been advocated to decrease the risk of T2DM in prediabetic subjects, which could reduce 3% absolute risk compared with no prevention [6][7][8]. The Da Qing Diabetes Prevention Study found that a 6-year lifestyle intervention program for those with impaired glucose tolerance (IGT) reduced the 17.3% cumulative incidence of diabetes (hazard ratio (HR): 0.55, 95% CI: 0.40-0.76) during the 23-year follow-up period [9].…”

Section: Introductionmentioning

confidence: 99%

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

Ma¹,

Wang²,

Wu³

2020

Journal of Diabetes Research

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Aims. Type 2 diabetes mellitus (T2DM) is a health challenge in China, and the economic outcomes of lifestyle intervention are critically important for policymakers. This study estimates the lifetime economic outcomes of lifestyle intervention among the prediabetic population in the Chinese context. Methods. We developed a mathematical model to compare the cost-effectiveness of lifestyle intervention and no prevention in the prediabetic population. Efficacy and safety, medical expenditure, and utility data were derived from the literature, which was assigned to model variables for estimating the quality-adjusted life-years (QALYs) and costs as well as incremental cost-effectiveness ratios (ICERs). The analysis was conducted from the perspective of Chinese healthcare service providers. One-way and probabilistic sensitivity analyses were performed. Results. Compared with no prevention, lifestyle intervention averted 9.53% of T2DM, which translated into an additional 0.52 QALYs at a saved cost of $700 by substantially reducing the probabilities of macro- and microvascular diseases. This finding indicated that lifestyle intervention was a dominant strategy. The sensitivity analyses showed the model outputs were robust. Conclusions. Lifestyle intervention is a very cost-effective alternative for prediabetic subjects and worth implementing in the Chinese healthcare system to reduce the disease burden related to T2DM.

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Narrative review of data supporting alternate first-line therapies over metformin in type 2 diabetes

Andraos,

Smith,

Tran

et al. 2024

J Diabetes Metab Disord

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Purpose Metformin has been the first-line treatment for type 2 diabetes mellitus as monotherapy or concomitantly with other glucose-lowering therapies due to its efficacy, safety, and affordability. Recent studies on the cardioprotective and renoprotective benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have influenced guidelines on diabetes management to consider these newer agents as alternative first-line therapies. This paper explores the literature supporting the use of these newer medications alone as a first-line agent in place of metformin. Methods A review of citations from the most recent guidelines along with a literature search via PubMed was completed to review (1) what, historically, made metformin first-line (2) if newer agents’ benefits remain when used without metformin (3) how newer agents compare against metformin when used without it. Results Evaluation of the historical literature was completed to summarize the key findings that support metformin as a first-line therapy agent. Additionally, an assessment of the literature reveals that the benefits of these two newer classes are independent of concomitant metformin therapy. Finally, studies have demonstrated that these newer agents can be either non-inferior or sometimes superior to metformin when used as monotherapy. Conclusion GLP-1 RA and SGLT-2i can be considered as first line monotherapies for select patients with high cardiovascular risks, renal disease, or weight loss requirements. However, pharmacoeconomic considerations along with lesser long-term safety outcomes should limit these agents’ use in certain patients as the management of diabetes continues to transition towards shared-decision making.

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

Cited by 11 publications

References 39 publications

Cost‐effectiveness of adding dapagliflozin to standard treatment for heart failure with reduced ejection fraction patients in China

Cost‐effectiveness of adding dapagliflozin to standard treatment for heart failure with reduced ejection fraction patients in China

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

Narrative review of data supporting alternate first-line therapies over metformin in type 2 diabetes

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