Pharmacoeconomic analysis of clinical efficiency of combined metformin (Siofor) - insulin therapy in patients with type 2 diabetes mellitus

Abstract

Aim. To assess expedience of metformin combination with long-acting insulin, determine optimal doses of metformin for patients with type 2 diabetesmellitus (DM2), and accomplish pharmacoeconomic analysis of clinical efficiency of various therapeutic modalities. Materials and methods. Patients with decompensated DM2 (n=126) were under observation for 1 year during which they received rational hypoglycemictherapy with metformin and long-acting insulin (LAI) at bedtime, with the dose being titrated until the desired level of glycemic control wasachieved. The patients were randomly allocated to the following 3 groups: group 1 (sulponylurea derivatives (SUD), LAI, and metformin at a doseof 1000 mg b.i.d.), group 2 (SUD, LAI, and metformin at 500 mg b.i.d.), group 3 (SUD and LAI). In case of postprandial glycemia >9 mmol/l at amaximum dose of SUD, it was replaced by short-acting insulin. Cost-effectiveness analysis of different therapeutic regimes was performed. Results. The cost of examination and treatment of patients given SUD and LAI in combination with metformin at a daily dose of 2000 mg to achievethe desired quality of glycemic control was lower compared with two other groups. Moreover, this therapy was most efficacious and ensured the desiredlevel of glycemic control in a greater number of patients. Cost-effectiveness analysis confirmed advantages of this treatment. Conclusion. Combined hypoglycemic therapy with SUD, LAI, and metformin (200 mg daily) has the advantage of lowest cost and maximum efficiencycompared with other modalities.

Keywords

• metformin
• insulin therapy
• combined therapy
• pharmacoeconomic analysis