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Cost Effectiveness of Exenatide Once Weekly Versus Insulin Glargine and Liraglutide for the Treatment of Type 2 Diabetes Mellitus in Greece

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Abstract

Objective

The objective of this study was to evaluate the long-term cost effectiveness of exenatide once weekly (ExQW) versus insulin glargine (IG) or liraglutide 1.2 mg (Lira1.2mg) for the treatment of adult patients with type 2 diabetes mellitus (T2DM) not adequately controlled on oral antidiabetic drug (OAD) therapy in Greece.

Methods

The published and validated Cardiff Diabetes Model was used to project clinical and economic outcomes over a patient’s lifetime. Clinical data were retrieved from a head-to-head clinical trial (DURATION 3) and a published network meta-analysis comparing ExQW with IG or Lira1.2mg, respectively. Following a Greek third-party payer perspective, direct medical costs related to drug acquisition, consumables, developed micro- and macrovascular complications, maintenance treatment, as well as treatment-related adverse events were considered. Cost and utility data were extracted from literature and publicly available official sources and assigned to model parameters to calculate total quality-adjusted life-years (QALYs) and total costs as well as incremental cost-effectiveness ratios (ICERs). Sensitivity analyses explored the impact of changes in input data.

Results

Over a patient’s lifetime, ExQW was associated with 0.458 or 0.039 incremental QALYs compared with IG or Lira1.2mg, respectively, at additional costs of €2061 or €110, respectively. The ICER for ExQW was €4499/QALY compared with IG and €2827/QALY compared with Lira1.2mg. Results were robust across various one-way and scenario analyses. At the defined willingness-to-pay threshold of €36,000/QALY, probabilistic sensitivity analysis showed that ExQW had a 100 or 88.2% probability of being cost effective relative to IG or Lira1.2mg, respectively.

Conclusions

ExQW was estimated to be cost effective relative to IG or Lira1.2mg for the treatment of T2DM in adults not adequately controlled on OAD therapy in Greece.

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Acknowledgements

The authors would like to thank AstraZeneca Greece for sponsoring this study.

Author information

Authors and Affiliations

  1. Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece

    Charalampos Tzanetakos, George Gourzoulidis & Nikos Maniadakis

  2. Department of Endocrinology and Metabolic Diseases, University of Thessaly School of Medicine, Larissa, Greece

    Alexandra Bargiota

  3. Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), “Aghia Sophia” Children’s Hospital, Athens, Greece

    Georgia Kourlaba

Authors
  1. Charalampos Tzanetakos
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  2. Alexandra Bargiota
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Corresponding author

Correspondence to Charalampos Tzanetakos.

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Funding

This study was funded by AstraZeneca Greece. However, the study sponsor had no interference in the study design, data collection, data analysis, or writing of the manuscript.

Conflict of interest

CT, AB, GK, GG, and NM have no personal or financial conflicts of interest.

Additional information

Previous presentation

Part of this study was previously presented at International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 19th Annual European Congress, Vienna, Austria, 29 October–2 November 2016. An abstract was submitted to this congress entitled “Cost-effectiveness of exenatide once weekly versus insulin glargine and liraglutide for the treatment of type 2 diabetes in Greece”.

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Tzanetakos, C., Bargiota, A., Kourlaba, G. et al. Cost Effectiveness of Exenatide Once Weekly Versus Insulin Glargine and Liraglutide for the Treatment of Type 2 Diabetes Mellitus in Greece. Clin Drug Investig 38, 67–77 (2018). https://doi.org/10.1007/s40261-017-0586-0

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