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Cost Effectiveness of Dipeptidyl Peptidase-4 Inhibitors for Type 2 Diabetes

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Abstract

Background

Dipeptidyl peptidase-4 (DPP-4) inhibitors are a new class of antidiabetic drugs used for treating type 2 diabetes mellitus. While many studies have reported on the cost-effectiveness of DPP-4 inhibitors for treating type 2 diabetes, a systematic review of economic evaluations of DPP-4 inhibitors is currently lacking.

Objectives

The aim of this systematic review was to assess the cost effectiveness of DPP-4 inhibitors for patients with type 2 diabetes.

Data Sources

MEDLINE, EMBASE, National Health Service Economic Evaluation Database (NHS EED), Web of Science, EconLit databases, and the Cochrane Library were searched in November 2013.

Study Eligibility Criteria, Participants and Interventions

Studies assessing the cost effectiveness of DPP-4 inhibitors for type 2 diabetes were eligible for analysis. DPP-4 inhibitor monotherapy or combinations with other antidiabetic agents were included in the review. The DPP-4 inhibitors were all marketed drugs. Two reviewers independently reviewed titles, abstracts, and articles sequentially to select studies for data abstraction based on the inclusion and exclusion criteria. Disagreements were resolved by consensus.

Study Appraisal and Synthesis Methods

The quality of included studies was assessed according to the 24-item checklist of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. The costs reported by the included studies were converted to US dollars via purchasing power parities (PPP) in the year 2013 using the CCEMG–EPPI-Center Cost Converter.

Results

A total of 11 published studies were selected for inclusion; all were cost-utility analyses. Nine studies were conducted from a payer perspective and one used a societal perspective; however, the perspective of the other study was unclear. Four studies were of good quality, six were of moderate quality, and one was of low quality. Of the seven studies comparing DPP-4 inhibitors plus metformin with sulfonylureas plus metformin, six concluded that DPP-4 inhibitors were cost effective in patients with type 2 diabetes who were no longer adequately controlled by metformin monotherapy. Five studies compared DPP-4 inhibitors with thiazolidinediones, and whether DPP-4 inhibitors were cost effective was uncertain. Only two economic evaluations provided data to compare DPP-4 inhibitors versus insulin, and the results favored the use of DPP-4 inhibitors as second-line therapy.

Limitations

Synthesis of the data was impossible because of heterogeneity in the methodology and data sources of the economic evaluations, and the inclusion criteria excluded conference abstracts. It was difficult to find reliable weightings for each of the items of the CHEERS checklist, and the ratings were dichotomous.

Conclusions and Implications of Key Findings

This study provides the first systematic evaluation of DPP-4 inhibitors for patients with type 2 diabetes. It found that, in patients with type 2 diabetes who do not achieve glycemic targets with antidiabetic monotherapy, DPP-4 inhibitors as add-on treatment may represent a cost-effective option compared with sulfonylureas and insulin. However, high-quality cost-effectiveness analyses that utilize long-term follow-up data and have no conflicts of interest are still needed.

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Acknowledgments

The evidence synthesis upon which this article was based was funded by Bristol-Myers Squibb (Shanghai, China) for Jinsong Geng, Yiwei Mao, Peng Zhang, and Yingyao Chen. Jinsong Geng also accepted funding from the China Medical Board (Grant Number 11-067) and the Shanghai Public Health 3-Year Program (GWDTR 201205, GWHW 2012S10) to go to the RAND Corporation in the US to complete the manuscript. The funders played no role in the study design; collection, analysis, and interpretation of data; writing of the report; or the decision to submit the paper for publication. They accept no responsibility for its contents.

All authors contributed to the conception and design of this work, and approved the final manuscript. Jinsong Geng, Yiwei Mao, and Peng Zhang were independent reviewers of the literature and were also responsible for study abstraction and writing of the manuscript. Hao Yu supervised all study activities and was responsible for the final manuscript review. Yingyao Chen is the overall guarantor of the manuscript.

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Authors and Affiliations

  1. National Key Laboratory of Health Technology Assessment (Ministry of Health), Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, 200032, China

    Jinsong Geng, Yiwei Mao, Peng Zhang & Yingyao Chen

  2. RAND Corporation, Pittsburgh, PA, 15213, USA

    Hao Yu

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  1. Jinsong Geng
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  2. Hao Yu
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Correspondence to Yingyao Chen.

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Registration This systematic review was registered with PROSPERO (Registration Number: CRD42013003354).

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Geng, J., Yu, H., Mao, Y. et al. Cost Effectiveness of Dipeptidyl Peptidase-4 Inhibitors for Type 2 Diabetes. PharmacoEconomics 33, 581–597 (2015). https://doi.org/10.1007/s40273-015-0266-y

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