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The place of DPP-4 inhibitors in the treatment algorithm of diabetes type 2: a systematic review of cost-effectiveness studies

The European Journal of Health Economics volume 18, pages 937–965 (2017)Cite this article

Abstract

Objective

To conduct a systematic review of cost-effectiveness, cost-utility, and cost-benefit studies of DPP-4 inhibitors for diabetes treatment versus other antidiabetics.

Methods

Three investigators searched the CRD York, Tufts CEA Registry, and MEDLINE databases through 2015. We reviewed all potentially relevant titles and abstracts, and screened full-text articles, according to inclusion criteria. We established a quality score for each study based on a 35-item list.

Results

A total of 295 studies were identified, of which 20 were included. The average quality score was 0.720 on a 0–1 scale. All studies were performed in high- and middle-income countries, using a 3rd-party payer perspective and randomized clinical trials to measure effectiveness. Sitagliptin, saxagliptin and vildagliptin had an ICER below 25,000 €/QALY, as second-line and as add-ons to metformin, in comparison to sulfonylureas. When compared with sitagliptin, liraglutide (GLP-1 receptor agonist) had an ICER of up to 22,724 €/QALY for the 1.2-mg dosage, and up to 32,869 €/QALY for the 1.8-mg dosage. Insulin glargine was dominant when compared with sitagliptin.

Conclusions

According to the WHO threshold applied to the country and year of each study, DPP-4 inhibitors were highly cost-effective as second-line, as add-ons to metformin, in comparison with sulfonylureas. More recent therapies (GLP-1 receptor agonists and insulin glargine) were highly cost-effective in comparison to DPP-4 inhibitors. These results were obtained, however, on the basis of a limited number of studies, relying on the same few clinical trials, and financed by manufacturers. Further independent research is needed to confirm these findings.

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Acknowledgments

This research had no external funding.

Author information

Authors and Affiliations

  1. Unit of Epidemiology of the Faculty of Medicine of Lisbon, Edifício Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisbon, Portugal

    Alexandre Baptista

  2. Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies Group, R. Marechal Saldanha, 1., 1249-069, Lisbon, Portugal

    Inês Teixeira & Sónia Romano

  3. Center for Evidence-Based Medicine (CEMBE) of the Faculty of Medicine at the University of Lisbon, Faculdade de Medicina da Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisbon, Portugal

    António Vaz Carneiro

  4. Escola Nacional de Saúde Pública and Centro de Investigação em Saúde Pública, Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-5605, Lisbon, Portugal

    Julian Perelman

Authors
  1. Alexandre Baptista
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  2. Inês Teixeira
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  3. Sónia Romano
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  4. António Vaz Carneiro
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Corresponding author

Correspondence to Alexandre Baptista.

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Conflict of interest

The authors declare that they have no conflict of interest. The authors have no affiliations or financial involvement that conflicts with the material presented in this paper. The authors are not employed in the pharmaceutical industry and, at the time of this research, had not performed nor were conducting any research study pertaining to the DPP-4 inhibitors group, nor were conducting any research for any of the marketing authorization holders of those therapeutic agents.

Appendix

Appendix

See Table 3.

Table 3 Detailed descriptions of study results
Full size table

Template for each study extracted and recorded information:

  • Title [incl. author(s) and journal]

  • Type of economic evaluation

  • Objective

  • Interventions

  • Comparators

  • Methods (Analytical approach; Perspective; Time Horizon; Population; Effectiveness data; Monetary benefit and utility valuation; Measure of benefit; Cost data; Discount rate; Analysis of uncertainty)

  • Results

  • Authors’ Conclusions

  • Limitations

  • Affiliation to pharmaceutical industry

Search strings for search:

  • Sitagliptin OR Saxagliptin OR Vildagliptin OR Alogliptin OR Linagliptin assessed in March 2015

  • Sitatgliptin AND Saxagliptin assessed in March 2015

  • Sitagliptin AND Vildagliptin assessed in March 2015

  • Sitagliptin AND Alogliptin assessed in March 2015

  • Sitagliptin AND Linagliptin assessed in March 2015

  • Saxagliptin AND Vildagliptin assessed in March 2015

  • Saxagliptin AND Alogliptin assessed in March 2015

  • Saxagliptin AND Linagliptin assessed in March 2015

  • Vildagliptin AND Alogliptin assessed in March 2015

  • Vildagliptin AND Linagliptin assessed in March 2015

  • Alogliptin AND Linagliptin assessed in March 2015

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Baptista, A., Teixeira, I., Romano, S. et al. The place of DPP-4 inhibitors in the treatment algorithm of diabetes type 2: a systematic review of cost-effectiveness studies. Eur J Health Econ 18, 937–965 (2017). https://doi.org/10.1007/s10198-016-0837-7

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  • DOI: https://doi.org/10.1007/s10198-016-0837-7

Keywords

  • Diabetes
  • Cost-effectiveness studies
  • DPP-4 inhibitors
  • Systematic review

JEL Classification

  • I1