Качественная клиническая практика (Aug 2019)

Pharmacoeconomic analysis of modern oral hypoglycemic agents with inadequate glycemic control on metformin

  • M. F. Kalashnikova,
  • D. Yu. Belousov,
  • A. E. Cheberda,
  • V. V. Fadeev

DOI
https://doi.org/10.24411/2588-0519-2019-10062
Journal volume & issue
Vol. 0, no. 1
pp. 27 – 52

Abstract

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The aim. Based on a pharmacoeconomic analysis (PHe) of the use of sodium-glucose cotransporter-2 inhibitors (iSGLT2) and dipeptidyl peptidase-4 (iDPP-4) inhibitors to determine the optimal treatment strategy in patients with type 2 diabetes mellitus (T2DM) with inadequate glycemic control in metformin. Methodology. PE based on the clinical data obtained in the Russian multicenter observational epidemiological study FORSIGHT-T2DM and data obtained by analyzing and synthesizing previously published results of randomized controlled trials. Based on the obtained by Markov modeling outcomes we conduct a cost-eff ectiveness analysis with a calculation of cost-eff ectiveness ratio (CER). The time horizon was 7 years. Results. The highest survival rate observed in patients taking alogliptin and empaglifl ozin. The lowest total direct medical costs was on linagliptin (511,830 rubles) and canaglifl ozin (663,571 rubles). The highest utility index according to the EQ-5D questionnaire in iDPP-4 group was on vildagliptin (0.496), in iSGLT2 group on dapaglifl ozin (0.489) and canaglifl ozin (0.489). The highest life years gained (LYG) in iDPP-4 group was on alogliptin (0.65 years); in iSGLT2 group on empaglifl ozin (0.51 year). The highest quality adjusted life years (QALY) was on alogliptin (0.32) and empaglifl ozin (0.25). The results of PHe showed that the lowest discounted CЕR<sub>LYG</sub> was on alogliptin (937 921 rubles) and empaglifl ozin (1 645 559 rubles). The lowest discounted CЕR<sub>QALY</sub> was on alogliptin (1 918 522 rubles) and empaglifl ozin (3 369 349 rubles). The sensitivity analysis confi rmed that increasing the price of empaglifl ozin and alogliptin by 25 % and / or reducing the proportion of patients who reached the target of HbA1c level by 25 % when taking empaglifl ozin or alogliptin did not change the most cost-eff ectiveness strategy. Conclusion. The results of this PE showed that alogliptin and empaglifl ozin have the lowest CЕR<sub>LYG</sub> and CЕR<sub>QALY</sub>. In patients with inadequate glycemic control on metformin add-on empaglifl ozin or alogliptin is the most cost-eff ective treatment strategies.

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