PMID- 33194963
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20240330
IS  - 2296-2565 (Print)
IS  - 2296-2565 (Electronic)
IS  - 2296-2565 (Linking)
VI  - 8
DP  - 2020
TI  - Cost-Effectiveness of Gliclazide-Based Intensive Glucose Control vs. Standard 
      Glucose Control in Type 2 Diabetes Mellitus. An Economic Analysis of the ADVANCE 
      Trial in Vietnam.
PG  - 562023
LID - 10.3389/fpubh.2020.562023 [doi]
LID - 562023
AB  - Introduction: ADVANCE was a large, multinational clinical study conducted over 5 
      years in type 2 diabetes mellitus (T2DM). In all, 11,140 patients were randomly 
      assigned to receive gliclazide-based intensive glucose control (IGC) or standard 
      glucose control (SGC). IGC was shown to significantly reduce the incidence of 
      major macrovascular and microvascular events (composite endpoint) or major 
      microvascular events compared with SGC, primarily by enhancing renal protection. 
      We assessed the cost-effectiveness of IGC vs. SGC, based on the ADVANCE results, 
      from a Vietnamese healthcare payer perspective. Materials and Methods: A 
      partitioned survival times model across five health states (no complications, 
      myocardial infarction, stroke, end-stage renal disease [ESRD], and 
      diabetes-related eye-disease) was designed. Time-to-event curves were informed by 
      the cumulative incidence of events and corresponding hazard ratios from the 
      ADVANCE study. Health outcomes were expressed in terms of ESRD avoided and 
      quality-adjusted life years (QALYs). Costs (in US $) comprised treatment costs 
      and health state costs. Utility weights and costs were documented from literature 
      reporting Vietnamese estimates. For sensitivity analyses, all parameters were 
      individually varied within their 95% confidence interval bounds (when available) 
      or within a +/-30% range. Results: Over a 5-year horizon, IGC avoided 6.5 
      additional ESRD events per 1,000 patients treated compared with SGC (IGC, 3.5 
      events vs. SGC, 10.0 events) and provided 0.016 additional QALYs (IGC, 3.570 
      QALYs vs. SGC, 3.555 QALYs). Total costs were similar for the two strategies 
      (IGC, $3,786 vs. SGC, $3,757). Although the total drug costs were markedly higher 
      for IGC compared with SGC ($1,703 vs. $873), this was largely offset by the 
      savings from better renal protection with IGC (IGC, $577 vs. SGC, $1,508). The 
      incremental cost-effectiveness ratio (ICER) of IGC vs. SGC was $1,878/QALY 
      gained, far below the threshold recommended by the World Health Organization 
      (i.e., 1-3 x gross domestic product per inhabitant  approximately $7,500 in Vietnam). The ICER 
      of IGC vs. SGC per ESRD event avoided was $4,559/event. The findings were robust 
      to sensitivity analysis. Conclusion: In Vietnam, gliclazide-based IGC was shown 
      to be cost-effective compared with SGC from a healthcare payer perspective, as 
      defined in the ADVANCE study.
CI  - Copyright (c) 2020 Nguyen-Thi, Nguyen, Le, Beillat and Ethgen.
FAU - Nguyen-Thi, Hai-Yen
AU  - Nguyen-Thi HY
AD  - Department of Pharmaceutical Administration, Faculty of Pharmacy, University of 
      Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
FAU - Nguyen, Nga Tq
AU  - Nguyen NT
AD  - Department of Pharmaceutical Administration, Faculty of Pharmacy, University of 
      Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
AD  - Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, 
      Queen's University Belfast, Belfast, United Kingdom.
FAU - Le, Nguyen Dang Tu
AU  - Le NDT
AD  - Department of Pharmaceutical Administration, Faculty of Pharmacy, University of 
      Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
FAU - Beillat, Maud
AU  - Beillat M
AD  - Servier Global Market Access & Health Economics and Outcomes Research, Suresnes, 
      France.
FAU - Ethgen, Olivier
AU  - Ethgen O
AD  - SERFAN Innovation, Namur, Belgium.
AD  - Department of Public Health, Epidemiology and Health Economics, University of 
      Liege, Liege, Belgium.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20201030
PL  - Switzerland
TA  - Front Public Health
JT  - Frontiers in public health
JID - 101616579
RN  - 0 (Blood Glucose)
RN  - 0 (Hypoglycemic Agents)
RN  - G4PX8C4HKV (Gliclazide)
MH  - Blood Glucose
MH  - Cost-Benefit Analysis
MH  - *Diabetes Mellitus, Type 2/drug therapy
MH  - *Gliclazide/therapeutic use
MH  - Humans
MH  - Hypoglycemic Agents/therapeutic use
MH  - Vietnam/epidemiology
PMC - PMC7661634
OTO - NOTNLM
OT  - Vietnam
OT  - cost-effectiveness
OT  - end-stage renal disease
OT  - gliclazide
OT  - hyperglycemia
OT  - intensive glucose control
OT  - type 2 diabetes mellitus
EDAT- 2020/11/17 06:00
MHDA- 2020/11/17 06:01
PMCR- 2020/10/30
CRDT- 2020/11/16 08:53
PHST- 2020/05/14 00:00 [received]
PHST- 2020/10/02 00:00 [accepted]
PHST- 2020/11/16 08:53 [entrez]
PHST- 2020/11/17 06:00 [pubmed]
PHST- 2020/11/17 06:01 [medline]
PHST- 2020/10/30 00:00 [pmc-release]
AID - 10.3389/fpubh.2020.562023 [doi]
PST - epublish
SO  - Front Public Health. 2020 Oct 30;8:562023. doi: 10.3389/fpubh.2020.562023. 
      eCollection 2020.