Pharmacoeconomic evaluation of dipeptidyl peptidase-4 inhibitors for the treatment of type 2 diabetes mellitus: a systematic literature review

Ruan, Zhen; Zou, Huimin; Lei, Qing; Ung, Carolina Oi Lam; Hong, Shi; Hu, Hao

doi:10.1080/14737167.2022.2042255

Cited by 3 publications

(4 citation statements)

References 65 publications

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“…A systematic review evaluated the cost-effectiveness of SGLT2i for T2D revealed that SGLT2i was more cost-effective than GLP-1RA and classic antidiabetic treatment options among patients who were not meeting HbA1c goals on metformin, especially for elevated CVD risk [ 7 ]. A similar study indicated that SGLT-2i and GLP-1RA were more cost-effective than DPP-4i and conventional hypoglycemic agents as second-line T2D treatment options [ 44 ]. Our comprehensive pharmacoeconomic evaluation of second-line treatment options for T2D has yielded some inconsistent results.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Newer Antidiabetic Drugs as Second-Line Treatment for Type 2 Diabetes: A Systematic Review

Zhu

Zhou

et al. 2023

Adv Ther

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Introduction Evidence from cardiovascular outcome trials (CVOTs) for newer antidiabetic drugs is increasingly influencing revised recommendations for second-line therapy in type 2 diabetes (T2D). This systematic review aimed to compare the cost-effectiveness of newer antidiabetic drugs specified as sodium-glucose cotransporter 2 inhibitor (SGLT2i), glucagon-like peptide 1 receptor agonist (GLP-1RA), and dipeptidyl peptidase 4 inhibitor (DPP-4i) for T2D in a second-line setting. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, and all relevant published studies were searched comprehensively in electronic databases, including PubMed, Embase, Web of Science, and International Health Technology Assessment database published from April 2023. The quality of the included studies was evaluated using Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 reporting checklists. Results We included 28 studies that met the inclusion criteria. Overall reporting of the identified studies largely met CHEERS 2022 recommendations. The CORE and Cardiff models were the most frequently utilized for pharmacoeconomic evaluation in T2D. Four studies consistently discovered that SGLT2i was more cost-effective than GLP-1RA in T2D who were not adequately controlled by metformin monotherapy. Four studies compared GLP-1RA with DPP-4i, sufonylurea (SU), or insulin. Except for one that demonstrated SU was cost-effective, all were GLP-1RA. Five studies revealed that SGLT2i was more cost-effective than DPP-4i or SU. Eleven studies indicated that DPP-4i was more cost-effective than traditional antidiabetic drugs. Four additional studies explored the cost-effectiveness of various antidiabetic drugs as second-line options, indicating that SU, SGLT2i, or meglitinides were more economically advantageous. The most common driven factors were the cost of new antidiabetic drugs. Conclusion Newer antidiabetic drugs as second line are the cost-effective option for T2D from the cost-effectiveness perspective, especially SGLT2i. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02612-z.

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Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Newer Antidiabetic Drugs as Second-Line Treatment for Type 2 Diabetes: A Systematic Review

Zhu

Zhou

et al. 2023

Adv Ther

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“…One significant barrier to using nNIADs more than oNI-ADs is that the price has consistently been much higher [6,10]. Despite the acquisition cost being much higher [11,[13][14][15], the literature on cost effectiveness has favoured the nNIADs [25][26][27][28][29][30][31] for second-line treatment. However, it remains unclear which of the nNIADs is the cost-effective choice, for which patients, and under which model assumptions [25].…”

Section: Key Points For Decision Makersmentioning

confidence: 99%

“…Other reviews in this area find that SGLT2 and GLP1 appear to be cost effective for patients with T2DM uncontrolled on MET and other background oNIADs. Ruan et al [30] focused on DPP4 and found it to be cost effective as a second-line treatment compared with sulfonylurea (SU) and insulin, but not SGLT2 and GLP1. Bagepally et al [28] found GLP1 to be cost effective compared with SU, DPP4, and TZD in high-income countries, while Bagepally et al [29] found SGLT2 to be cost effective against SU, but not DPP4, in high-income countries.…”

Section: Connecting Main Findings To Other Studiesmentioning

confidence: 99%

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

Laursen

Jørgensen²,

Vestergaard

et al. 2023

PharmacoEconomics

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Background We performed a systematic overview of the cost-effectiveness analyses (CEAs) comparing non-insulin antidiabetic drugs (NIADs) with other NIADs for the treatment of type 2 diabetes mellitus (T2DM), using decision-analytical modelling (DAM), focusing on both the economic results and the underlying methodological choices. Methods Eligible studies were CEAs using DAM to compare NIADs within the glucagon-like peptide-1 (GLP1) receptor agonists, sodium-glucose cotransporter-2 (SGLT2) inhibitors, or dipeptidyl peptidase-4 (DPP4) inhibitor classes with other NIADs within those classes for the treatment of T2DM. The PubMed, Embase and Econlit databases were searched from 1 January 2018 to 15 November 2022. Two reviewers screened the studies for relevance by titles and abstracts and then for eligibility via full-text screening, extracted the data from the full texts and appendices, and then stored the data in a spreadsheet. ResultsThe search yielded 890 records and 50 studies were eligible for inclusion. The studies were mainly based on a European setting (60%). Industry sponsorship was found in 82% of studies. The CORE diabetes model was used in 48% of the studies. GLP1 and SGLT2 products were the main comparators in 31 and 16 studies, respectively, while one study had DPP4 and two had no easily discernible main comparator. Direct comparison between SGLT2 and GLP1 occurred in 19 studies. At a class level, SGLT2 dominated GLP1 in six studies and was cost effective against GLP1 once as part of a treatment pathway. GLP1 was cost effective in nine studies and not cost effective against SGLT2 in three studies. At a product level, oral and injectable semaglutide, and empagliflozin, were cost effective against other within-class products. Injectable and oral semaglutide were more frequently found cost effective in these comparisons, with some conflicting results. Most of the modelled cohorts and treatment effects were sourced from randomised controlled trials. The following model assumptions varied depending on the class of the main comparator: choice of and reasoning behind risk equations, the time until the treatment switch, and how often the comparators were discontinued. Diabetes-related complications were emphasised on par with quality-adjusted life-years as model outputs. The main quality issues were regarding the description of alternatives, the perspective of analysis, the measurement of costs and consequences, and patient subgroups. Conclusion The included CEAs using DAMs have limitations that hinder their ability to inform decision makers on the cost-effective choice: lack of updated reasoning behind the choice of key model assumptions, over-reliance on risk equations based on older treatment practices, and sponsorship bias. The question of which NIAD is cost effective for the treatment of which T2DM patient is a pressing one and the answer remains unclear. 1471 Cost-Effectiveness Studies Comparing Non-Insulin Pharmaceuticals for T2DM 2 Methods This systematic review was conducted in 2021, updated in 2022, a...

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“…Metformin is the most commonly prescribed drug for the treatment of type 2 diabetes (T2DM) as well as other indications requiring insulin-sensitizing drugs, such as polycystic ovary syndrome (PCOS), presenting with insulin resistance, hyperandrogenemia and female infertility [ 1 ]. Recently, metformin has been repurposed and tested for a number of other diseases [ 2 , 3 , 4 , 5 ], such as dementia, and also has implications for healthy ageing [ 6 ]. Metformin is known to be safe in long term use.…”

Section: Introductionmentioning

confidence: 99%

Identification of Novel Intronic SNPs in Transporter Genes Associated with Metformin Side Effects

Schweighofer

Strasser

Obermayer

et al. 2023

Genes

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Metformin is a widely used and effective medication in type 2 diabetes (T2DM) as well as in polycystic ovary syndrome (PCOS). Single nucleotide polymorphisms (SNPs) contribute to the occurrence of metformin side effects. The aim of the present study was to identify intronic genetic variants modifying the occurrence of metformin side effects and to replicate them in individuals with T2DM and in women with PCOS. We performed Next Generation Sequencing (Illumina Next Seq) of 115 SNPs in a discovery cohort of 120 metformin users and conducted a systematic literature review. Selected SNPs were analysed in two independent cohorts of individuals with either T2DM or PCOS, using 5′-3′exonucleaseassay. A total of 14 SNPs in the organic cation transporters (OCTs) showed associations with side effects in an unadjusted binary logistic regression model, with eight SNPs remaining significantly associated after appropriate adjustment in the discovery cohort. Five SNPs were confirmed in a combined analysis of both replication cohorts but showed different association patterns in subgroup analyses. In an unweighted polygenic risk score (PRS), the risk for metformin side effects increased with the number of risk alleles. Intronic SNPs in the OCT cluster contribute to the development of metformin side effects in individuals with T2DM and in women with PCOS and are therefore of interest for personalized therapy options.

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Pharmacoeconomic evaluation of dipeptidyl peptidase-4 inhibitors for the treatment of type 2 diabetes mellitus: a systematic literature review

Cited by 3 publications

References 65 publications

Cost-Effectiveness of Newer Antidiabetic Drugs as Second-Line Treatment for Type 2 Diabetes: A Systematic Review

Cost-Effectiveness of Newer Antidiabetic Drugs as Second-Line Treatment for Type 2 Diabetes: A Systematic Review

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

Identification of Novel Intronic SNPs in Transporter Genes Associated with Metformin Side Effects

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