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Real-World Cost-Effectiveness: Lower Cost of Treating Patients to Glycemic Goal with Liraglutide versus Exenatide

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Abstract

Introduction

While the liraglutide effect and action in diabetes (LEAD-6) clinical trial compared the efficacy and safety of liraglutide once daily (LIRA) to exenatide twice daily (EXEN) in adult patients with type 2 diabetes, few studies have explored the associated per-patient costs of glycemic goal achievement of their use in a real-world clinical setting.

Methods

This retrospective cohort study used integrated medical and pharmacy claims linked with glycated hemoglobin A1C (A1C) results from the IMS Patient-Centric Integrated Data Warehouse. Patients’ ≥18 years and naïve to incretin therapies during a 6-month pre-index period, with ≥1 prescription for LIRA or EXEN between January 2010 and December 2010, were included. Patients with evidence of insulin use (pre- or post-index) were excluded. Only patients who were persistent on their index treatment during a 180-day post-index period were included. Follow-up A1C assessments were based on available laboratory data within 45 days before or after the 6-month post-index point in time. Diabetes-related pharmacy costs over the 6-month post-index period were captured and included costs for both the index drugs and concomitant diabetes medications.

Results

234 LIRA and 182 EXEN patients were identified for the analysis. The adjusted predicted diabetes-related pharmacy costs per patient over the 6-month post-index period were higher for LIRA compared to EXEN ($2,002 [95% confidence interval (CI): $1,981, $2,023] vs. $1,799 [95% CI: $1,778, $1,820]; P < 0.001). However, a higher adjusted predicted percentage of patients on LIRA reached A1C < 7% goal (64.4% [95% CI: 63.5, 65.3] vs. 53.6% [95% CI: 52.6, 54.6]; P < 0.05), translating into lower average diabetes-related pharmacy costs per successfully treated patient for LIRA as compared to EXEN ($3,108 vs. $3,354; P < 0.0001).

Conclusions

Although predicted diabetes-related pharmacy costs were greater with LIRA vs. EXEN, a higher proportion of patients on LIRA achieved A1C < 7%, resulting in a lower per-patient cost of A1C goal achievement with LIRA compared to EXEN.

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Acknowledgments

The authors wish to thank Nicole Cooper of MedVal Scientific Information Services, LLC, for providing professional writing and editorial assistance. Funding to support the preparation of this manuscript was provided to MedVal by Novo Nordisk Inc. This manuscript was prepared according to the International Society for Medical Publication Professionals’ “Good Publication Practice for Communicating Company-Sponsored Medical Research: the GPP2 Guidelines” and the International Committee of Medical Journal Editors’ “Uniform Requirements for Manuscripts Submitted to Biomedical Journals”. Sponsorship and article processing charges for this study were funded by Novo Nordisk Inc. (NJ, USA).

Conflict of interest

Jon Bouchard is an employee and shareholder of Novo Nordisk with no further declarations of interest. Marjan Massoudi is an employee and shareholder of Novo Nordisk with no further declarations of interest. Jakob Langer is an employee and shareholder of Novo Nordisk with no further declarations of interest. Mitch DeKoven is an employee of IMS Health with no further declarations of interest. Won Chan Lee is an employee of IMS Health with no further declarations of interest. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. All named authors meet the ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Compliance with ethics guidelines

This article does not contain any studies with human or animal subjects performed by any of the authors.

Open Access

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

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Authors and Affiliations

  1. Health Economics and Outcomes Research, IMS Health, 1725 Duke Street, Suite 510, Alexandria, VA, 22314, USA

    Mitch DeKoven & Won Chan Lee

  2. Novo Nordisk Inc., Plainsboro, NJ, USA

    Jonathan Bouchard, Marjan Massoudi & Jakob Langer

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  1. Mitch DeKoven
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  2. Won Chan Lee
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Correspondence to Mitch DeKoven.

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DeKoven, M., Lee, W.C., Bouchard, J. et al. Real-World Cost-Effectiveness: Lower Cost of Treating Patients to Glycemic Goal with Liraglutide versus Exenatide. Adv Ther 31, 202–216 (2014). https://doi.org/10.1007/s12325-014-0098-8

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