PMID- 25849542
OWN - NLM
STAT- MEDLINE
DCOM- 20160325
LR  - 20181202
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 10
IP  - 4
DP  - 2015
TI  - The short-term cost-effectiveness of once-daily liraglutide versus once-weekly 
      exenatide for the treatment of type 2 diabetes mellitus in the United States.
PG  - e0121915
LID - 10.1371/journal.pone.0121915 [doi]
LID - e0121915
AB  - BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease with 
      substantial morbidity, mortality, and economic impacts. Glucagon-like peptide-1 
      (GLP-1) receptor agonists, such as once-daily (QD) liraglutide and once-weekly 
      (QW) exenatide, are FDA-approved treatment for T2DM. Head-to-head trials and 
      meta-analyses comparing these agents have reported clinically meaningful 
      improvements but small differences in glycemic control between both agents. In 
      this study, we calculate and compare the cost-effectiveness implications of these 
      alternative effectiveness outcomes. METHODS: We developed a decision model to 
      evaluate the short-term cost-effectiveness of exenatide QW 2 mg versus 
      liraglutide QD 1.8 mg in T2DM patients, with effectiveness measured as reduction 
      in glycated hemoglobin (HbA1c). In the base case, the model tracks change in 
      HbA1c and direct medical expenditure over a 6-month time horizon. We calculated 
      and compared the cost per 1% reduction in HbA1c of models populated with clinical 
      data from a head-to-head randomized, controlled trial (DURATION-6) and a network 
      meta-analysis. Expenditure inputs were derived from wholesale acquisition costs 
      and published sources. RESULTS: In the base case, 6-month expenditure for the 
      liraglutide and exenatide strategies were $3,509 and $2,618, respectively. Using 
      clinical data from DURATION-6 and the network meta-analysis, the liraglutide 
      strategy had an incremental cost per 1% reduction in HbA1c of $4,773 and $27,179, 
      respectively. The most influential model parameters were drug costs, magnitude of 
      HbA1c reduction in patients on treatment for >1 month, and liraglutide 
      gastrointestinal adverse event rate. In probabilistic sensitivity analyses (PSA) 
      using DURATION-6 data, the exenatide strategy was optimal at willingness-to-pay 
      levels below $4,800 per 1% reduction in HbA1c. In a PSA using meta-analysis data, 
      the exenatide strategy was dominant. CONCLUSIONS: Our modeled results demonstrate 
      that the effectiveness and cost-effectiveness of liraglutide QD 1.8 mg relative 
      to exenatide QW 2 mg depend largely on the chosen source of the clinical data.
FAU - Wang, Bruce
AU  - Wang B
AD  - Elysia Group, LLC, New York, New York, United States of America.
FAU - Roth, Joshua A
AU  - Roth JA
AD  - Department of Pharmacy, University of Washington, Seattle, Washington, United 
      States of America; Public Health Sciences Division, Fred Hutchinson Cancer 
      Research Center, Seattle, Washington, United States of America.
FAU - Nguyen, Hiep
AU  - Nguyen H
AD  - AstraZeneca, Fort Washington, Pennsylvania, United States of America.
FAU - Felber, Eugene
AU  - Felber E
AD  - Bristol-Myers Squibb Company, New York, New York, United States of America.
FAU - Furnback, Wes
AU  - Furnback W
AD  - Elysia Group, LLC, New York, New York, United States of America.
FAU - Garrison, Louis P
AU  - Garrison LP
AD  - Department of Pharmacy, University of Washington, Seattle, Washington, United 
      States of America.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150407
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Peptides)
RN  - 0 (Venoms)
RN  - 839I73S42A (Liraglutide)
RN  - 9P1872D4OL (Exenatide)
SB  - IM
MH  - Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Diabetes Mellitus, Type 2/drug therapy/*economics
MH  - Exenatide
MH  - Female
MH  - Humans
MH  - Liraglutide/administration & dosage/*economics
MH  - Male
MH  - *Models, Economic
MH  - Peptides/administration & dosage/*economics
MH  - United States
MH  - Venoms/administration & dosage/*economics
PMC - PMC4388383
COIS- Competing Interests: BW, WF, JR, and LG are consultants for Bristol-Myers Squibb 
      Company. HN is an employee of AstraZeneca. EF is an employee of Bristol-Myers 
      Squibb Company. BW and WF are employees of Elysia Group, LLC. Exenatide is 
      marketed by AstraZeneca. This study was funded by Bristol-Myers Squibb Company. 
      This does not alter the authors' adherence to PLOS ONE policies on sharing data 
      and materials.
EDAT- 2015/04/08 06:00
MHDA- 2016/03/26 06:00
PMCR- 2015/04/07
CRDT- 2015/04/08 06:00
PHST- 2014/11/10 00:00 [received]
PHST- 2015/02/07 00:00 [accepted]
PHST- 2015/04/08 06:00 [entrez]
PHST- 2015/04/08 06:00 [pubmed]
PHST- 2016/03/26 06:00 [medline]
PHST- 2015/04/07 00:00 [pmc-release]
AID - PONE-D-14-50482 [pii]
AID - 10.1371/journal.pone.0121915 [doi]
PST - epublish
SO  - PLoS One. 2015 Apr 7;10(4):e0121915. doi: 10.1371/journal.pone.0121915. 
      eCollection 2015.