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Cost-Utility Analysis of Dapagliflozin Versus Saxagliptin Treatment as Monotherapy or Combination Therapy as Add-on to Metformin for Treating Type 2 Diabetes Mellitus

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Abstract

Objective

To assess the long-term cost effectiveness of dapagliflozin (DAPA) and saxagliptin (SAXA) separately or together in patients with type 2 diabetes mellitus (T2DM) inadequately controlled by metformin (MET).

Methods

Five head-to-head randomised controlled trials of the efficacy of DAPA and SAXA in type 2 diabetes mellitus (T2DM) patients were found by searching PubMed, Embase and Cochrane from inception to October 2019. The lifetime disease progression and long-term effectiveness of therapy in patients were projected by the United Kingdom Prospective Diabetes Study Outcome Model 2 (UKPDS OM2) in three T2DM therapeutic groups: DAPA + SAXA, DAPA and SAXA. Each group used DAPA and/or SAXA as an add-on therapy to MET. The study took the perspective of Chinese healthcare service providers. Univariate, scenario and probabilistic sensitivity analyses were performed.

Results

The quality-adjusted life-years (QALYs) value of the DAPA + SAXA, SAXA and DAPA groups were 11.28, 11.26 and 11.45 years, respectively. The total costs were US$27,954.84, US$23,254.46 and US$25,608.49, respectively. DAPA was dominant over DAPA + SAXA. The DAPA + SAXA group presented an estimated QALY gain of 0.02 and a total cost increase of US$4700.39 over the SAXA group, with an incremental cost of US$217,530.10 per QALY. Compared with the SAXA group, the DAPA group had a QALY gain of 0.19 years and a total cost increase of US$2354.04, for an incremental cost of US$12,191.97 per QALY. The pharmacoeconomic results were robust to univariate, scenario and probabilistic sensitivity analyses.

Conclusions

Compared with DAPA + SAXA or SAXA, DAPA appears to be a cost-effective therapy as add-on to MET for Chinese patients whose T2DM is insufficiently controlled by MET.

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Acknowledgements

The UKPDS Outcomes Model Software (Version 2) were provided by The Chancellor, Masters & Scholars of the University of Oxford.

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Author notes

  1. Shanshan Hu and Xun Deng contributed equally to this work.

Authors and Affiliations

  1. Department of Pharmacy, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China

    Shanshan Hu, Xun Deng, Yanjiao Ma, Zhilei Li, Yuhang Wang & Yong Wang

  2. Laboratory of Research of New Chinese Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China

    Xun Deng & Yong Wang

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  1. Shanshan Hu
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Correspondence to Yong Wang.

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Funding

This work was supported by the Wu Jieping Medical Foundation of China (Grant numbers 320.6750.2020–04-22).

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The authors declare that they have no conflict of interest.

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Author contributions

YW and SH contributed to the study conception and design. Material preparation, data collection and analysis were performed by SH and YW. YM and ZL supervised the process of data collection and analysis. The first draft of the manuscript was written by SH and XD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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The data and materials generated or analysed during this study are available from the corresponding author on reasonable request.

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Hu, S., Deng, X., Ma, Y. et al. Cost-Utility Analysis of Dapagliflozin Versus Saxagliptin Treatment as Monotherapy or Combination Therapy as Add-on to Metformin for Treating Type 2 Diabetes Mellitus. Appl Health Econ Health Policy 19, 69–79 (2021). https://doi.org/10.1007/s40258-020-00603-7

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