PMID- 24708176
OWN - NLM
STAT- MEDLINE
DCOM- 20150223
LR  - 20181202
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 17
IP  - 7
DP  - 2014 Jul
TI  - Cost-effectiveness of metformin plus vildagliptin compared with metformin plus 
      sulphonylurea for the treatment of patients with type 2 diabetes mellitus: a 
      Portuguese healthcare system perspective.
PG  - 499-507
LID - 10.3111/13696998.2014.912986 [doi]
AB  - OBJECTIVE: To evaluate the cost-effectiveness of vildagliptin plus metformin vs 
      generic sulphonylurea plus metformin in patients with type 2 diabetes mellitus, 
      not controlled with metformin, from a Portuguese healthcare system perspective. 
      METHODS: A cost-effectiveness model was constructed using risk equations from the 
      UK Prospective Diabetes Study Outcomes Model with a 10,000-patient cohort and a 
      lifetime horizon. The model predicted microvascular and macrovascular 
      complications and mortality in yearly cycles. Patients entered the model as 
      metformin monotherapy failures and switched to alternative treatments (metformin 
      plus basal-bolus insulin and subsequently metformin plus intensive insulin) when 
      glycated hemoglobin A1c >7.5% was reached. Baseline patient characteristics and 
      clinical variables were derived from a Portuguese epidemiological study. Cost 
      estimates were based on direct medical costs only. One-way and probabilistic 
      sensitivity analyses were conducted to test the robustness of the model. RESULTS: 
      There were fewer non-fatal diabetes-related adverse events (AEs) in patients 
      treated with metformin plus vildagliptin compared with patients treated with 
      metformin plus sulphonylurea (6752 vs 6815). Addition of vildagliptin compared 
      with sulphonylurea led to increased drug acquisition costs but reduced costs of 
      AEs, managing morbidities, and monitoring patients. Treatment with metformin plus 
      vildagliptin yielded a mean per-patient gain of 0.1279 quality-adjusted life 
      years (QALYs) and a mean per-patient increase in total cost of euro1161, giving an 
      incremental cost-effectiveness ratio (ICER) of euro9072 per QALY. Univariate 
      analyses showed that ICER values were robust and ranged from euro4195 to euro16,052 per 
      QALY when different parameters were varied. LIMITATIONS: The model excluded 
      several diabetes-related morbidities, such as peripheral neuropathy and 
      ulceration, and did not model second events. Patients were presumed to enter the 
      model with no diabetes-related complications. CONCLUSION: Treatment with 
      metformin plus vildagliptin compared with metformin plus sulphonylurea is 
      expected to result in a lower incidence of diabetes-related AEs and to be a 
      cost-effective treatment strategy.
FAU - Viriato, Daniel
AU  - Viriato D
AD  - Novartis Farma SA , Porto Salvo , Portugal.
FAU - Calado, Frederico
AU  - Calado F
FAU - Gruenberger, Jean-Bernard
AU  - Gruenberger JB
FAU - Ong, Siew Hwa
AU  - Ong SH
FAU - Carvalho, Davide
AU  - Carvalho D
FAU - Silva-Nunes, Jose
AU  - Silva-Nunes J
FAU - Johal, Sukhvinder
AU  - Johal S
FAU - Viana, Ricardo
AU  - Viana R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140423
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Nitriles)
RN  - 0 (Pyrrolidines)
RN  - 0 (Sulfonylurea Compounds)
RN  - 9100L32L2N (Metformin)
RN  - I6B4B2U96P (Vildagliptin)
RN  - PJY633525U (Adamantane)
SB  - IM
MH  - Adamantane/administration & dosage/*analogs & derivatives/economics
MH  - Computer Simulation
MH  - Cost-Benefit Analysis
MH  - Diabetes Complications/*economics/prevention & control
MH  - Diabetes Mellitus, Type 2/complications/*drug therapy/*economics
MH  - Dipeptidyl-Peptidase IV Inhibitors/administration & dosage/economics
MH  - Drug Therapy, Combination/economics
MH  - Female
MH  - Humans
MH  - Hypoglycemic Agents/administration & dosage/economics
MH  - Male
MH  - Metformin/administration & dosage/*economics/therapeutic use
MH  - Middle Aged
MH  - Models, Economic
MH  - Nitriles/administration & dosage/*economics
MH  - Portugal
MH  - Prospective Studies
MH  - Pyrrolidines/administration & dosage/*economics
MH  - Quality-Adjusted Life Years
MH  - Risk Factors
MH  - Sulfonylurea Compounds/administration & dosage/*economics
MH  - Vildagliptin
OTO - NOTNLM
OT  - Cost-effectiveness
OT  - Diabetes mellitus
OT  - Metformin
OT  - Portugal
OT  - Sulphonylurea
OT  - Vildagliptin
EDAT- 2014/04/09 06:00
MHDA- 2015/02/24 06:00
CRDT- 2014/04/09 06:00
PHST- 2014/04/09 06:00 [entrez]
PHST- 2014/04/09 06:00 [pubmed]
PHST- 2015/02/24 06:00 [medline]
AID - 10.3111/13696998.2014.912986 [doi]
PST - ppublish
SO  - J Med Econ. 2014 Jul;17(7):499-507. doi: 10.3111/13696998.2014.912986. Epub 2014 
      Apr 23.