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Analisi di costo-efficacia della terapia combinata con pioglitazone nel trattamento del diabete mellito di tipo 2 in Italia

Cost-effectiveness analysis of pioglitazone therapy in DMT2

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PharmacoEconomics Italian Research Articles

Summary

Introduction

Pioglitazone (from the group of thiazolidinediones) is now available in Italy for oral combination therapy for type 2 diabetes, after monotherapy with metformin or sulfonylurea has failed to control hyperglycaemia. Clinical trials have proved it can significantly improve HbA1c levels and lipid profiles.

Objective

Since treatment with pioglitazone, though effective, costs more than standard medications, an analysis was conducted to test its cost-effectiveness. Comparators were metformin and sulfonylurea.

Methods

Long term clinical data are not available about pioglitazone effectiveness, so a published Markov model was used to simulate the occurrence of severe complications and the life expectancy in a cohort of type 2 diabetic patients from the beginning of treatment until death. Baseline characteristics were UKPDS overweight patients’, but sensitivity analysis was performed on data from the CODE-2 Italian sub-study too. Local Italian unit costs for treatment and complications were used. The perspective was the National Health Service’s.

Results

The model outcomes show that combination therapy with pioglitazone improves life expectancy more than any other treatment combination. After discounting costs and life expectancy at 5%, the incremental cost per life year gained (CLYG) of pioglitazone (PIO) 30 mg + metformin (MET) versus sulfonylurea (SU) + MET was € 41,859. The CLYG of PIO 30 mg + SU was € 20,981 versus MET + SU. The CLYG of PIO 15 mg + SU versus MET + SU was € 49,013.

Conclusions

The present study found that pioglitazone improves life expectancy and reduces complications at a cost that is fairly acceptable in terms of established cost-effectiveness thresholds. Pioglitazone represents an opportunity for the health care budget in Italy and should be one of the preferred options in the treatment of type 2 diabetes patients for the approved indications.

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Authors and Affiliations

  1. Wolters Kluwer Health, Adis International Ltd Italia, Via Lanino 5, 20144, Milano, Italia

    Carlo Lucioni & S. Mazzi

  2. Institute for Medical Informatics and Biostatistics, Basilea, Switzerland

    K. Neeser

Authors
  1. Carlo Lucioni
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  2. S. Mazzi
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  3. K. Neeser
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Correspondence to Carlo Lucioni.

Additional information

I peer reviewers, per questo articolo, sono stati coordinati da Livio Garattini.

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Lucioni, C., Mazzi, S. & Neeser, K. Analisi di costo-efficacia della terapia combinata con pioglitazone nel trattamento del diabete mellito di tipo 2 in Italia. Pharmacoeconomics-Ital-Res-Articles 6, 81–93 (2004). https://doi.org/10.1007/BF03320626

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