Titre du document / Document title

Comparing the long-term cost-effectiveness of repaglinide plus metformin versus nateglinide plus metformin in type 2 Diabetes patients with inadequate glycaemic control: An application of the CORE Diabetes Model in type 2 Diabetes

Auteur(s) / Author(s)

PALMER Andrew J. ; ROZE Stéphane ; LAMMERT Morten ; VALENTINE William J. ; MINSHALL Michael E. ; NICKLASSON Lars ; GALL Mari-Anne ; SPINAS Giatgen A. ;

Résumé / Abstract

Objectives: As an example application of the CORE Diabetes Model in type 2 diabetes, we simulated the cost-effectiveness of repaglinide/ metformin combination therapy versus nateglinide/metformin for treatment of individuals with type 2 diabetes with an inadequate response to sulphonylurea, metformin, or fixed dose glyburide/metformin. Methods The CORE Diabetes Model was used to simulate long-term outcomes for a cohort of individuals with type 2 diabetes treated with either repaglinide/metformin or nateglinide/metformin. HbA^1c changes for each regimen were taken from a comparative study. At the end of the study, changes in HbA^1c from baseline were -1.28% points and -0.67% points for repaglinide/ metformin and nateglinide/metformin, respectively. Median final doses were 5.0 mg/day for repaglinide, 360 mg/day for nateglinide and 2000 mg/day metformin in each treatment arm. Costs were calculated as the annual costs for drugs plus costs of complications (US Medicare perspective) over a 30-year period. Life expectancy (LE) and quality-adjusted life expectancy (QALE) were calculated. Outcomes and costs were discounted at 3% annually. Results: With repaglinide/metformin, improved glycaemic control led to projected decreases in complication rates, improvement of LE and QALE by 0.15 and 0.14 years respectively, and total cost savings of $3,662/person over the 30-year period. Repaglinide/metformin had a 96% probability that the incremental costs per quality-adjusted life year gained would be $20,000 or less, and a 66% probability that repaglinide/metformin would be cost-saving compared to nateglinide/metformin. Sensitivity analyses supported the validity and reliability of the results. Conclusions: In the health economic context, repaglinide/metformin combination was dominant to nateglinide/metformin. The CORE Diabetes Model is a tool to help third-party reimbursement payers identify treatments for type 2 diabetes that are good value for money.

Revue / Journal Title

Current medical research and opinion. Supplement   ISSN 0141-9951 

Source / Source

2004, vol. 20, n^o1, pp. S41-S51

Langue / Language

Anglais

Editeur / Publisher

Librapharm, [Reading], ROYAUME-UNI  (1975) (Revue)

Localisation / Location

INIST-CNRS, Cote INIST : 16405 S, 35400012058401.0030