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Original research| Volume 9, ISSUE 1, P39-47, February 2015

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Cost-effectiveness of dapagliflozin (Forxiga®) added to metformin compared with sulfonylurea added to metformin in type 2 diabetes in the Nordic countries

      Highlights

      • Dapagliflozin – a sodium-glucose co-transporter 2 inhibitor working independently of insulin.
      • Long term diabetes-related complications are estimated by a Cardiff simulation model.
      • Data from a 52-week trial comparing dapagliflozin and SU in combination with metformin is used.
      • Metformin + dapagliflozin is cost-effective vs. metformin + SU in Nordic type 2 diabetes patients.

      Abstract

      Aims

      The aim of this study was to assess the long-term cost-effectiveness of dapagliflozin (Forxiga®) added to metformin, compared with sulfonylurea (SU) added to metformin, in Nordic Type 2 diabetes mellitus (T2DM) patients inadequately controlled on metformin.

      Methods

      Data from a 52-week clinical trial comparing dapagliflozin and SU in combination with metformin was used in a Cardiff simulation model to estimate long term diabetes-related complications in a cohort of T2DM patients. Costs and QALYs were calculated from a healthcare provider perspective and estimated over a patient's lifetime.

      Results

      Compared with metformin + SU, the cost per QALY gained with dapagliflozin + metformin was €7944 in Denmark, €5424 in Finland, €4769 in Norway, and €6093 in Sweden. Metformin + dapagliflozin was associated with QALY gains ranging from 0.236 in Norway to 0.278 in Sweden and incremental cost ranging from €1125 in Norway to €1962 in Denmark. Results were robust across both one-way and probabilistic sensitivity analyses. Results were driven by weight changes associated with each treatment.

      Conclusions

      Results indicate that metformin + dapagliflozin is associated with gains in QALY compared with metformin + SU in Nordic T2DM patients inadequately controlled on metformin. Dapagliflozin treatment is a cost-effective treatment alternative for Type 2 diabetes in all four Nordic countries.

      Keywords

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      References

        • Bogelund M.
        • Vilsboll T.
        • Faber J.
        • Henriksen J.E.
        • Gjesing R.P.
        • Lammert M.
        Patient preferences for diabetes management among people with type 2 diabetes in Denmark – a discrete choice experiment.
        Curr. Med. Res. Opin. 2011; 27: 2175-2183
        • Yu A.P.
        • Wu E.Q.
        • Birnbaum H.G.
        • Emani S.
        • Fay M.
        • Pohl G.
        • et al.
        Short-term economic impact of body weight change among patients with type 2 diabetes treated with antidiabetic agents: analysis using claims, laboratory, and medical record data.
        Curr. Med. Res. Opin. 2007; 23: 2157-2169
        • Zhang P.
        • Zhang X.
        • Brown J.
        • Vistisen D.
        • Sicree R.
        • Shaw J.
        • et al.
        Global healthcare expenditure on diabetes for 2010 and 2030.
        Diabetes Res. Clin. Pract. 2010; 87: 293-301
        • UKPDS 33
        Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group.
        Lancet. 1998; 352: 837-853
        • NICE
        Type 2 diabetes: the management of type 2 diabetes.
        NICE Clinical Guideline 87. National Institute for Health and Clinical Excellence, 2009, May
        • Inzucchi S.E.
        • Bergenstal R.M.
        • Buse J.B.
        • Diamant M.
        • Ferrannini E.
        • Nauck M.
        • et al.
        Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).
        Diabetologia. 2012; 55: 1577-1596
        • Matza L.S.
        • Boye K.S.
        • Yurgin N.
        • Brewster-Jordan J.
        • Mannix S.
        • Shorr J.M.
        • et al.
        Utilities and disutilities for type 2 diabetes treatment-related attributes.
        Qual. Life Res. 2007; 16: 1251-1265
        • Currie C.J.
        • Morgan C.L.
        • Poole C.D.
        • Sharplin P.
        • Lammert M.
        • McEwan P.
        Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes.
        Curr. Med. Res. Opin. 2006; 22: 1523-1534
        • Anderson J.W.
        • Kendall C.W.
        • Jenkins D.J.
        Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies.
        J. Am. Coll. Nutr. 2003; 22: 331-339
        • Peters A.L.
        Patient and treatment perspectives: revisiting the link between type 2 diabetes, weight gain, and cardiovascular risk.
        Cleve. Clin. J. Med. 2009; 76: S20-S27
        • Bodegard J.
        • Sundstrom J.
        • Svennblad B.
        • Ostgren C.J.
        • Nilsson P.M.
        • Johansson G.
        Changes in body mass index following newly diagnosed type 2 diabetes and risk of cardiovascular mortality: a cohort study of 8486 primary-care patients.
        Diabetes Metab. 2013; 39: 306-313
        • Bolin K.
        • Gip C.
        • Mork A.C.
        • Lindgren B.
        Diabetes, healthcare cost and loss of productivity in Sweden 1987 and 2005 – a register-based approach.
        Diabet. Med. 2009; 26: 928-934
        • Pi-Sunyer F.X.
        The impact of weight gain on motivation, compliance, and metabolic control in patients with type 2 diabetes mellitus.
        Postgrad. Med. 2009; 121: 94-107
        • Ross S.A.
        • Dzida G.
        • Vora J.
        • Khunti K.
        • Kaiser M.
        • Ligthelm R.J.
        Impact of weight gain on outcomes in type 2 diabetes.
        Curr. Med. Res. Opin. 2011; 27: 1431-1438
        • Nauck M.A.
        • Del Prato S.
        • Meier J.J.
        • Duran-Garcia S.
        • Rohwedder K.
        • Elze M.
        • et al.
        Dapagliflozin versus glipizide as add-on therapy in patients with type 2 diabetes who have inadequate glycemic control with metformin: a randomized, 52-week, double-blind, active-controlled noninferiority trial.
        Diabetes Care. 2011; 34: 2015-2022
        • Granstrom O.
        • Bergenheim K.
        • McEwan P.
        • Sennfalt K.
        • Henriksson M.
        Cost-effectiveness of saxagliptin (Onglyza(R)) in type 2 diabetes in Sweden.
        Prim. Care Diabetes. 2012; 6: 127-136
        • Mount Hood 4 Modeling Group
        Computer modeling of diabetes and its complications: a report on the Fourth Mount Hood Challenge Meeting.
        Diabetes Care. 2007; 30: 1638-1646
        • Clarke P.M.
        • Gray A.M.
        • Briggs A.
        • Farmer A.J.
        • Fenn P.
        • Stevens R.J.
        • et al.
        A model to estimate the lifetime health outcomes of patients with type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68).
        Diabetologia. 2004; 47: 1747-1759
        • Lundkvist J.
        • Berne C.
        • Bolinder B.
        • Jönsson L.
        The economic and quality of life impact of hypoglycemia.
        Eur. J. Health Econ. 2005; 50: 197-202
        • Waugh N.
        • Cummins E.
        • Royle P.
        • Clar C.
        • Marien M.
        • Richter B.
        • et al.
        Newer agents for blood glucose control in type 2 diabetes: systematic review and economic evaluation.
        Health Technol. Assess. 2010; 14: 1-248
        • Gerdtham U.G.
        • Clarke P.
        • Hayes A.
        • Gudbjornsdottir S.
        Estimating the cost of diabetes mellitus-related events from inpatient admissions in Sweden using administrative hospitalization data.
        Pharmacoeconomics. 2009; 27: 81-90
        • Henriksson F.
        Applications of economic models in healthcare: the introduction of pioglitazone in Sweden.
        Pharmacoeconomics. 2002; 20: 43-53
        • Stewart W.C.
        • Stewart J.A.
        • Mychaskiw M.A.
        Cost-effectiveness of latanoprost and timolol maleate for the treatment of glaucoma in Scandinavia and the United Kingdom, using a decision-analytic health economic model.
        Eye (Lond.). 2009; 23: 132-140
        • Schwarz B.
        • Gouveia M.
        • Chen J.
        • Nocea G.
        • Jameson K.
        • Cook J.
        • et al.
        Cost-effectiveness of sitagliptin-based treatment regimens in European patients with type 2 diabetes and haemoglobin A1c above target on metformin monotherapy.
        Diabetes Obes. Metab. 2008; 10: 43-55
        • Jonsson L.
        • Bolinder B.
        • Lundkvist J.
        Cost of hypoglycemia in patients with Type 2 diabetes in Sweden.
        Value Health. 2006; 9: 193-198
        • Clarke P.
        • Gray A.
        • Holman R.
        Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62).
        Med. Decis. Making. 2002; 22: 340-349
        • Lane S.
        • Levy A.
        • Sambrook J.
        • Mukherjee J.
        • Leahy M.
        • Tildesley H.
        The impact on utilities of weight loss and weight gain among Canadian patients with type 2 diabetes.
        Value Health. 2012; 15: A183
        • Dennett S.L.
        • Boye K.S.
        • Yurgin N.R.
        The impact of body weight on patient utilities with or without type 2 diabetes: a review of the medical literature.
        Value Health. 2008; 11: 478-486
        • Wilding J.P.
        • Woo V.
        • Soler N.G.
        • Pahor A.
        • Sugg J.
        • Rohwedder K.
        • et al.
        Long-term efficacy of dapagliflozin in patients with type 2 diabetes mellitus receiving high doses of insulin: a randomized trial.
        Ann. Intern. Med. 2012; 156: 405-415
        • Wing R.R.
        • Lang W.
        • Wadden T.A.
        • Safford M.
        • Knowler W.C.
        • Bertoni A.G.
        • et al.
        Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes.
        Diabetes Care. 2011; 34: 1481-1486
        • Fajardo Montanana C.
        • Hernandez Herrero C.
        • Rivas Fernandez M.
        Less weight gain and hypoglycaemia with once-daily insulin detemir than NPH insulin in intensification of insulin therapy in overweight Type 2 diabetes patients: the PREDICTIVE BMI clinical trial.
        Diabet. Med. 2008; 25: 916-923
        • Currie C.J.
        • McEwan P.
        • Peters J.R.
        • Patel T.C.
        • Dixon S.
        The routine collation of health outcomes data from hospital treated subjects in the Health Outcomes Data Repository (HODaR): descriptive analysis from the first 20,000 subjects.
        Value Health. 2005; 8: 581-590
        • Barry H.C.
        • Ebell M.H.
        • Hickner J.
        Evaluation of suspected urinary tract infection in ambulatory women: a cost-utility analysis of office-based strategies.
        J. Fam. Pract. 1997; 44: 49-60
        • Caro J.J.
        • Stillman I.O.
        • Danel A.
        • Getsios D.
        • McEwan P.
        Cost effectiveness of rimonabant use in patients at increased cardiometabolic risk: estimates from a Markov model.
        J. Med. Econ. 2007; 10: 239-254