Clinical Drug Investigation

, Volume 32, Issue 3, pp 189–202 | Cite as

Cost Effectiveness of Saxagliptin and Metformin versus Sulfonylurea and Metformin in the Treatment of Type 2 Diabetes Mellitus in Germany

A Cardiff Diabetes Model Analysis
  • Wilma Erhardt
  • Klas Bergenheim
  • Isabelle Duprat-Lomon
  • Phil McEwanEmail author
Original Research Article


Background: The lack of adequate glycaemic control for patients with type 2 diabetes mellitus (T2DM), especially with existing second-line therapies, represents an unmet medical need. Of the newer therapies, the incretin-based medicines, such as saxagliptin, look promising to consolidate second-line pharmacotherapy.

Objective: This study evaluates the long-term economic consequences of saxagliptin versus sulfonylurea (glipizide) as second-line therapy when used in combination with metformin after failure of monotherapy treatment with metformin, in patients with T2DM in Germany.

Methods: A published discrete event simulation model with a fixed-time increment was used to model the effects of different treatment scenarios over a 40-year (life-) time horizon. Disease progression was modelled using evidence from the United Kingdom Prospective Diabetes Study (UKPDS) 68. The treatment sequence matched that of published German guidelines, and efficacy and safety data were derived from published sources. The model assumes that quality-adjusted life-years (QALYs) are affected by complications, hypoglycaemic events and weight change over a lifetime. Costs were specific to the German setting, where sulfonylureas are generic. Costs and effects were discounted annually at 3%. The extended perspective of the national sick funds was adopted, and recommendations from the Institute for Quality and Efficiency in Health Care (IQWiG) were considered.

Results: In the base-case analysis, treatment with saxagliptin plus metformin was associated with a lower incidence of both symptomatic and severe hypoglycaemic events, resulting in an incremental benefit of 0.12 QALYs and an incremental cost-effectiveness ratio (ICER) of €13 931 per QALY gained compared with sulfonylurea plus metformin (year of costing 2009). Modest reductions in all macro- and microvascular complications were seen in those receiving saxagliptin plus metformin compared with sulfonylurea plus metformin. Sensitivity analysis showed that treatment-related weight changes, as a risk factor for complications, represent the most influential driver of cost effectiveness.

Conclusion: The study demonstrated improved outcomes with saxagliptin at a cost that would likely be considered acceptable in the German setting. Furthermore, the findings of the sensitivity analysis suggest that the results are robust to various assumptions concerning input variables and modelling assumptions.


Metformin Sulfonylurea Exenatide Repaglinide Glipizide 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was funded by and the writing of the manuscript supported by an unrestricted grant from Bristol-Myers Squibb, Munich, Germany and AstraZeneca, Mölndal, Sweden. Wilma Erhardt and Isabelle Duprat-Lomon are full-time employees of Bristol-Myers Squibb. Klas Bergenheim is a full-time employee of AstraZeneca. Phil McEwan is a full-time employee of Cardiff Research Consortium, Cardiff, UK. The authors would like to thank Mahendra Rai, Rebecca Townsend and Sunita Nair, Cardiff Research Consortium, for providing editorial support for the manuscript.


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Copyright information

© Adis Data Information BV 2012

Authors and Affiliations

  • Wilma Erhardt
    • 1
  • Klas Bergenheim
    • 2
  • Isabelle Duprat-Lomon
    • 3
  • Phil McEwan
    • 4
    Email author
  1. 1.Bristol-Myers SquibbMunichGermany
  2. 2.AstraZenecaMölndalSweden
  3. 3.Europe HEOR — CV & MetabolicsBristol-Myers Squibb, Rueil MalmaisonFrance
  4. 4.Cardiff Research Consortium LtdCardiffUK

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