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Cost Effectiveness of Combination Therapy with Pioglitazone for Type 2 Diabetes Mellitus from a German Statutory Healthcare Perspective

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Abstract

Background: Pioglitazone has been approved in Europe for oral combination therapy for type 2 diabetes mellitus. Along with other agents of the thiazolidinedione class, it has a novel intracellular mechanism of action. Clinical trials with pioglitazone have confirmed a strong product profile in terms of control of blood glucose and lipids. However, the drug acquisition cost for pioglitazone is greater than standard medications for type 2 diabetes. Long-term data regarding the cost effectiveness of pioglitazone-based combination therapy are not available.

Objective: To evaluate, using a decision analysis model, the cost effectiveness of pioglitazone-based combination therapy compared with relevant alternative medications for the treatment of type 2 diabetes in Germany.

Methods: This study compared the clinical effects and costs of pioglitazone 30mg added to metformin in patients who failed metformin monotherapy and pioglitazone added to a sulphonylurea in patients who failed sulphonylurea monotherapy, with the most relevant treatment alternatives. A published and validated Markov model was adapted to reflect the management of type 2 diabetes. This simulated the number of severe complications occurring and the mean life expectancy of a diabetic cohort, which was based on the overweight group of the UK Prospective Diabetes Study at year 6 of follow-up. Drug treatment costs, other costs for general management of type 2 diabetes and the costs of complications were combined to compute overall lifetime treatment costs from the perspective of the German statutory healthcare system in 2002.

Results: Combination therapy with pioglitazone/metformin was associated with a higher life expectancy (15.2 years) relative to sulphonylurea/metformin (14.9 years) or acarbose/metformin (14.7 years). Likewise, pioglitazone/sulphonylurea (15.5 years) was superior to metformin/sulphonylurea (14.9 years) and acarbose/sulphonylurea (14.8 years). Undiscounted incremental cost-effectiveness ratios in comparison to the next best strategy were €20 002 per life-year gained (LYG) for pioglitazone/metformin versus sulphonylurea/metformin, and €8707 per LYG for pioglitazone/sulphonylurea versus metformin/sulphonylurea. After discounting costs and life expectancy at 5% per year, the incremental cost-effectiveness ratio was €47 636 per LYG for pioglitazone/metformin versus sulphonylurea/metformin, and €19 745 per LYG for pioglitazone/sulphonylurea versus metformin/ sulphonylurea.

Conclusions: In this model, with its underlying assumptions and data, combination therapy with pioglitazone increased life expectancy in overweight type 2 diabetes patients at acceptable cost compared with other well established medications in Germany. These findings should be re-evaluated as soon as additional evidence becomes available from the currently ongoing long-term clinical and economic studies.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

  2. Calculation method of HbA1c drift over time: cohort average HbA1C in year t = cohort HbA1C at baseline — treatment effect on HbA1C + (annual treatment-independent increase in HbA1C × t number of years). The annual treatmentindependent increase in HbA1C is 0.2 % in the second year after treatment start, and the HbA1C drift decreases continuously over time to 0.05 % after 10 years.

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Acknowledgements

Funding for the study was provided by Takeda Pharma (Aachen, Germany) to IMIB (Basel, Switzerland). The institutional authors had full and independent control over the contents of the manuscript. Dr Georg Lübben is an employee of Takeda Pharma (Aachen, Germany). Dr Uwe Siebert and his institutions did not receive any funding for this collaboration.

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  1. Institute for Medical Informatics and Biostatistics (IMIB), Clarastrasse 15, Basel, CH-4058, Switzerland

    Kurt Neeser & Wendelin Schramm

  2. Takeda Pharma, Aachen, Germany

    Georg Lübben

  3. Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Uwe Siebert

  4. Harvard Center for Risk Analysis, Harvard School of Public Health, Boston, Massachusetts, USA

    Uwe Siebert

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  1. Kurt Neeser
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Neeser, K., Lübben, G., Siebert, U. et al. Cost Effectiveness of Combination Therapy with Pioglitazone for Type 2 Diabetes Mellitus from a German Statutory Healthcare Perspective. PharmacoEconomics 22, 321–341 (2004). https://doi.org/10.2165/00019053-200422050-00006

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