Review of Models Used in Economic Analyses of New Oral Treatments for Type 2 Diabetes Mellitus
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Economic models are considered to be important, as they help evaluate the long-term impact of diabetes treatment. To date, it appears that no article has reviewed and critically appraised the cost-effectiveness models developed to evaluate new oral treatments [glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors] for type 2 diabetes mellitus (T2DM).
This study aimed to provide insight into the utilization of cost-effectiveness modelling methods. The focus of our study was aimed at the applicability of these models, particularly around the major assumptions related to the clinical parameters (glycated haemoglobin [A1c], systolic blood pressure [SBP], lipids and weight) used in the models, and subsequent clinical outcomes.
MEDLINE and EMBASE were searched from 1 January 2004 to 14 February 2013 in order to identify published cost-effectiveness evaluations for the treatment of T2DM by new oral treatments (GLP-1 receptor agonists and DPP-4 inhibitors). Once identified, the articles were reviewed and grouped together according to the type of model. The following data were captured for each study: comparators; country; evaluation and key cost drivers; time horizon; perspective; discounting rates; currency/year; cost-effectiveness threshold, sensitivity analysis; and cost-effectiveness analysis curves.
A total of 15 studies were identified in our review. Nearly all of the models utilized a health care payer perspective and provided a lifetime horizon. The CORE Diabetes Model, UK Prospective Diabetes Study (UKPDS) Outcomes Model, Cardiff Diabetes Model, Centers for Disease Control and Prevention (CDC) Diabetes Cost-Effectiveness Group Model and Diabetes Mellitus Model were cited. With the exception of two studies, all of the studies made significant assumptions surrounding the impact of GLP-1 receptor agonists or DPP-4 inhibitors on clinical parameters and subsequent short- and long-term outcomes. Moreover, often the differences in the clinical parameters were relatively small (e.g. 1 or 2 mmHg in blood pressure) and would not be considered by many as clinically important. Yet, the impact of these small clinical changes often resulted in large lifetime changes in health outcomes in the models. In particular, many studies assumed that changes in weight associated with the therapies would equate to improved outcomes, despite limited evidence for this assumption. Although the new oral treatments were regarded as cost effective in most studies based upon the studies reviewed, the validity of these projections, particularly for the longer time frames, is questionable. Indeed, although most of these studies have been conducted in the last 5 years, recent trial evidence has already questioned the validity of most of these studies.
It is clear that a number of changes are required in the evaluation of diabetes therapies. First and foremost, the basic models need to be updated to include contemporary important clinical trial data assessing hard clinical outcomes in patients with diabetes. Second, there should be less emphasis on 40-year or lifetime costs and consequences of the therapies and a greater focus on short-term (5-year) and intermediate-term (10-year) outcomes. Practice is continually evolving, and the probability that these models would provide any valid predictions beyond 10 years is remote. Third, all modellers should immediately remove the basic assumption that small clinically inconsequential changes in A1c, SBP, lipids and weight result in major clinical improvements in patients. Future models should aim to include all relevant treatment outcomes, whether these relate to effects on underlying diabetes and its complications or to short- or long-term side effects of treatment. We need to explore why cost-saving interventions could benefit further from adding patient characteristics, which may be able to better predict the use of lower-cost alternatives. Moreover, the vast array of different clinical, cost and utility data used in the different models reviewed makes it apparent that a uniform methodology should be developed for diabetes economic models. In this manner, future models could be run using the same data, which would allow for more acceptable comparability between studies.
- Drucker DJ, Nauck MA. The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet. 2006;368(9548):1696–705. CrossRef
- American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care. 2013;36(Suppl 1):S11–66. CrossRef
- http://www.fda.gov/drugs/drugsafety/ucm343187.htm. Accessed 30 August 2013
- Beaudet A, Palmer JL, Timlin L, Wilson B, Bruhn D, Boye KS, Lloyd A. Cost-utility of exenatide once weekly compared with insulin glargine in patients with type 2 diabetes in the UK. J Med Econ. 2011;14(3):357–66. CrossRef
- Scheen AJ. Dipeptidylpeptidase-4 (DPP-4) inhibitors are favourable to glucagon-like peptide-1 (GLP-1) receptor agonists: yes. Eur J Intern Med. 2012;23(2):126–31. CrossRef
- Sinha A, Rajan M, Hoerger T, Pogach L. Costs and consequences associated with newer medications for glycemic control in type 2 diabetes. Diabetes Care. 2010;33(4):695–700. CrossRef
- Lage MJ, Fabunmi R, Boye KS, Misurski DA. Comparison of costs among patients with type 2 diabetes treated with exenatide or sitagliptin therapy. Adv Ther. 2009;26(2):217–29. CrossRef
- Tarride JE, Hopkins R, Blackhouse G, et al. A review of methods used in long-term cost-effectiveness models of diabetes mellitus treatment. Pharmacoeconomics. 2010;28(4):255–77. CrossRef
- Klarenbach S, Cameron C, Singh S, Ur E. Cost-effectiveness of second-line antihyperglycemic therapy in patients with type 2 diabetes mellitus inadequately controlled on metformin. CMAJ. 2011;183(16):1213–20. CrossRef
- Schwarz B, Gouveia M, Chen J, Nocea G, Jameson K, Cook J, Krishnarajah G, Alemao E, Yin D, Sintonen H. 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(Suppl 1):43–55. CrossRef
- Woehl A, Evans M, Tetlow AP, McEwan P. Evaluation of the cost effectiveness of exenatide versus insulin glargine in patients with sub-optimally controlled type 2 diabetes in the United Kingdom. Cardiovasc Diabetol. 2008;7:24. CrossRef
- Davies MJ, Chubb BD, Smith IC, Valentine WJ. Cost-utility analysis of liraglutide compared with sulphonylurea or sitagliptin, all as add-on to metformin monotherapy in type 2 diabetes mellitus. Diabet Med. 2012;29(3):313–20. CrossRef
- Lee WC, Conner C, Hammer M. Cost-effectiveness of liraglutide versus rosiglitazone, both in combination with glimepiride in treatment of type 2 diabetes in the US. Curr Med Res Opin. 2011;27(5):897–906. CrossRef
- Valentine WJ, Palmer AJ, Lammert M, Langer J, Brändle M. Evaluating the long-term cost-effectiveness of liraglutide versus exenatide BID in patients with type 2 diabetes who fail to improve with oral antidiabetic agents. Clin Ther. 2011;33(11):1698–712. CrossRef
- Goodall G, Costi M, Timlin L, Reviriego J, Sacristán JA, Smith-Palmer J, Dilla T. Cost-effectiveness of exenatide versus insulin glargine in Spanish patients with obesity and type 2 diabetes mellitus. Endocrinol Nutr. 2011;58(7):331–40. CrossRef
- Mittendorf T, Smith-Palmer J, Timlin L, Happich M, Goodall G. Evaluation of exenatide vs insulin glargine in type 2 diabetes: cost-effectiveness analysis in the German setting. Diabetes Obes Metab. 2009;11(11):1068–79. CrossRef
- Ray JA, Boye KS, Yurgin N, Valentine WJ, Roze S, McKendrick J, Tucker DM, Foos V, Palmer AJ. Exenatide versus insulin glargine in patients with type 2 diabetes in the UK: a model of long-term clinical and cost outcomes. Curr Med Res Opin. 2007;23(3):609–22. CrossRef
- Grzeszczak W, Czupryniak L, Kolasa K, Sciborski C, Lomon ID, McEwan P. The cost-effectiveness of saxagliptin versus NPH insulin when used in combination with other oral antidiabetes agents in the treatment of type 2 diabetes mellitus in Poland. Diabetes Technol Ther. 2011;14(1):65–73. CrossRef
- Granström O, Bergenheim K, McEwan P, Sennfält K, Henriksson M. Cost-effectiveness of saxagliptin (Onglyza®) in type 2 diabetes in Sweden. Prime Care Diabetes. 2012;6(2):127–36. CrossRef
- McEwan P, Evans M, Bergenheim K. A population model evaluating the costs and benefits associated with different oral treatment strategies in people with type 2 diabetes. Diabetes Obes Metab. 2010;12(7):623–30. CrossRef
- Brändle M, Erny-Albrecht KM, Goodall G, Spinas GA, Streit P, Valentine WJ. Exenatide versus insulin glargine: a cost-effectiveness evaluation in patients with type 2 diabetes in Switzerland. Int J Clin Pharmacol Ther. 2009;47(8):501–15. CrossRef
- Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59. CrossRef
- Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72. CrossRef
- Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–54. CrossRef
- Scirica BM, Bhatt DL, Braunwald E, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369(14):1317–26. CrossRef
- Orlowski JP, Wateska L. The effects of pharmaceutical firm enticements on physician prescribing patterns: there’s no such thing as a free lunch. Chest. 1992;102:270–3. CrossRef
- Adang E, Voordijk L, Jan van der Wilt G, Ament A. Cost-effectiveness analysis in relation to budgetary constraints and reallocative restrictions. Health Policy. 2005;74:146–56. CrossRef
- Eichler HG, Kong SX, Gerth WC, Mavros P, Jönsson B. Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge? Value Health. 2004;7:518–28. CrossRef
- Neumann PJ, Auerbach HR, Cohen JT, Greenberg D. Low-value services in value-based insurance design. Am J Manag Care. 2010;16:280–6.
- Review of Models Used in Economic Analyses of New Oral Treatments for Type 2 Diabetes Mellitus
Volume 32, Issue 1 , pp 15-27
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- 1. Center for Outcomes Research, University of Illinois College of Medicine at Peoria, One Illini Drive, Peoria, IL, 61656-1649, USA
- 3. OSF Healthcare, 1420 W Pioneer Park, Peoria, IL, 61615, USA
- 2. School of Public Health, 2-040 Li Ka Shing Center for Health Research Innovation, University of Alberta, Edmonton, AB, Canada