PMID- 22793669
OWN - NLM
STAT- MEDLINE
DCOM- 20130312
LR  - 20221207
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 15 Suppl 2
DP  - 2012
TI  - Long-term cost-utility analysis of exenatide once weekly versus insulin glargine 
      for the treatment of type 2 diabetes patients in the US.
PG  - 6-13
LID - 10.3111/13696998.2012.708691 [doi]
AB  - OBJECTIVE: The purpose of this study was to estimate the long-term cost-utility 
      of treating type 2 diabetes mellitus (T2DM) patients with exenatide once weekly 
      (EQW) compared with insulin glargine (IG) from a US payer perspective. METHODS: A 
      validated computer simulation model, the CORE Diabetes Model, was used to project 
      lifetime clinical outcomes and direct medical costs. Direct medical costs 
      included pharmacy costs and costs associated with the management of diabetes and 
      its complications. The model was populated using patient characteristics (mean 
      age: 57.9 years; mean diabetes duration: 7.9 years; mean HbA1(c): 8.3%; mean body 
      mass index [BMI]: 32.3 kg/m(2)) and clinical data from a phase 3 clinical trial 
      that compared EQW with IG in T2DM patients on a background of metformin alone or 
      a combination of metformin and a sulphonylurea (DURATION-3). All EQW patients 
      were assumed to have stayed on treatment for 3 years before switching to IG. 
      Health outcomes and costs were discounted at 3% per year. Complication costs were 
      derived from published sources. A range of sensitivity analyses was performed. 
      RESULTS: Over a lifetime horizon, and compared with IG, EQW was associated with 
      an incremental cost of $3914 (SD = 2923). EQW was projected to increase life 
      expectancy by 0.135 (SD = 0.216) years and to improve quality-adjusted life 
      expectancy by 0.246 (SD = 0.147) quality-adjusted life years (QALYs), generating 
      an incremental cost-effectiveness ratio (ICER) of $15,936/QALY. Assuming a 
      payer's willingness to pay threshold of $50,000/QALY, EQW is therefore 
      cost-effective compared to IG. One-way and probabilistic sensitivity analyses 
      confirmed EQW's cost-effective profile. LIMITATIONS: Short-term changes (26 
      weeks) in surrogate end-points (e.g., HbA1(c,) weight, complications) from one 
      clinical trial were used to project long-term future effects on clinical 
      outcomes. CONCLUSIONS: Treatment with EQW is projected to be cost-effective 
      compared to treatment with IG.
FAU - Samyshkin, Yevgeniy
AU  - Samyshkin Y
AD  - IMS Health, London, UK.
FAU - Guillermin, Anne-Laure
AU  - Guillermin AL
FAU - Best, Jennie H
AU  - Best JH
FAU - Brunell, Steven C
AU  - Brunell SC
FAU - Lloyd, Adam
AU  - Lloyd A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120716
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin, Long-Acting)
RN  - 0 (Peptides)
RN  - 0 (Venoms)
RN  - 2ZM8CX04RZ (Insulin Glargine)
RN  - 9P1872D4OL (Exenatide)
SB  - IM
MH  - Administration, Cutaneous
MH  - Computer Simulation
MH  - Cost Savings
MH  - Cost of Illness
MH  - Cost-Benefit Analysis
MH  - Diabetes Complications/economics
MH  - Diabetes Mellitus, Type 2/complications/*drug therapy/*economics
MH  - Disease Management
MH  - Exenatide
MH  - Female
MH  - Glycated Hemoglobin
MH  - Humans
MH  - Hypoglycemic Agents/*administration & dosage/*economics
MH  - Insulin Glargine
MH  - Insulin, Long-Acting/*administration & dosage/*economics
MH  - Male
MH  - Middle Aged
MH  - Monte Carlo Method
MH  - Peptides/*administration & dosage/*economics
MH  - Quality-Adjusted Life Years
MH  - United States
MH  - Venoms/*administration & dosage/*economics
EDAT- 2012/07/17 06:00
MHDA- 2013/03/13 06:00
CRDT- 2012/07/17 06:00
PHST- 2012/07/17 06:00 [entrez]
PHST- 2012/07/17 06:00 [pubmed]
PHST- 2013/03/13 06:00 [medline]
AID - 10.3111/13696998.2012.708691 [doi]
PST - ppublish
SO  - J Med Econ. 2012;15 Suppl 2:6-13. doi: 10.3111/13696998.2012.708691. Epub 2012 
      Jul 16.