PMID- 33267884
OWN - NLM
STAT- MEDLINE
DCOM- 20210211
LR  - 20210211
IS  - 1741-7015 (Electronic)
IS  - 1741-7015 (Linking)
VI  - 18
IP  - 1
DP  - 2020 Dec 3
TI  - Choice across 10 pharmacologic combination strategies for type 2 diabetes: a 
      cost-effectiveness analysis.
PG  - 378
LID - 10.1186/s12916-020-01837-x [doi]
LID - 378
AB  - BACKGROUND: Clinical guidelines recommend a stepped-escalation treatment strategy 
      for type 2 diabetes (T2DM). Across multiple treatment strategies varying in 
      efficacy and costs, no clinical or economic studies directly compared them. This 
      study aims to estimate and compare the cost-effectiveness of 10 commonly used 
      pharmacologic combination strategies for T2DM. METHODS: Based on Chinese 
      guideline and practice, 10 three-stepwise add-on strategies were identified, 
      which start with metformin, then switch to metformin plus one oral drug (i.e., 
      sulfonylurea, thiazolidinedione, alpha-glucosidase inhibitor, glinide, or DPP-4 
      inhibitor) as second line, and finally switch to metformin plus one injection 
      (i.e., insulin or GLP-1 receptor agonist) as third line. A cohort of 10,000 
      Chinese patients with newly diagnosed T2DM was established. From a healthcare 
      system perspective, the Cardiff model was used to estimate the cost-effectiveness 
      of the strategies, with clinical data sourced from a systematic review and 
      indirect treatment comparison of 324 trials, costs from claims data of 1164 T2DM 
      patients, and utilities from an EQ-5D study. Outcome measures include costs, 
      quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios 
      (ICERs), and net monetary benefits (NMBs). RESULTS: Over 40-year simulation, the 
      costs accumulated for a patient ranged from $7661 with strategy 1 to $14,273 with 
      strategy 10, while the QALY gains ranged from 13.965 with strategy 1 to 14.117 
      with strategy 8. Strategy 7 was dominant over seven strategies (strategies 2~6, 
      9~10) with higher QALYs but lower costs. Additionally, at a willingness-to-pay 
      threshold of $30,787/QALY (i.e., 3 times GDP/capita for China), strategy 7 was 
      cost-effective compared with strategy 1 (ICER of strategy 7 vs. 1, $3371/QALY) 
      and strategy 8 (ICER of strategy 8 vs. 7, $132,790/QALY). Ranking the strategies 
      by ICERs and NMBs, strategy 7 provided the best value for money when compared to 
      all other strategies, followed by strategies 5, 9, 8, 1, 3, 6, 10, 2, and 4. 
      Scenario analyses showed that patients insist on pharmacologic treatments 
      increased their QALYs (0.456~0.653) at an acceptable range of cost increase 
      (ICERs, $1450/QALY~$12,360/QALY) or even at cost saving compared with those not 
      receive treatments. CONCLUSIONS: This study provides evidence-based references 
      for diabetes management. Our findings can be used to design the essential drug 
      formulary, infer clinical practice, and help the decision-maker design 
      reimbursement policy.
FAU - Gu, Shuyan
AU  - Gu S
AD  - Center for Health Policy and Management Studies, School of Government, Nanjing 
      University, Nanjing, Jiangsu, China.
AD  - Center for Health Policy Studies, School of Public Health, School of Medicine, 
      Zhejiang University, Hangzhou, Zhejiang, China.
FAU - Shi, Lizheng
AU  - Shi L
AD  - Department of Global Health Management and Policy, School of Public Health and 
      Tropical Medicine, Tulane University, New Orleans, LA, USA.
FAU - Shao, Hui
AU  - Shao H
AD  - Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University 
      of Florida, Gainesville, FL, USA.
FAU - Wang, Xiaoyong
AU  - Wang X
AD  - Health Insurance Office, Shandong Provincial Hospital Affiliated to Shandong 
      First Medical University, Jinan, Shandong, China.
FAU - Hu, Xiaoqian
AU  - Hu X
AD  - Center for Health Policy Studies, School of Public Health, School of Medicine, 
      Zhejiang University, Hangzhou, Zhejiang, China.
AD  - Current address: College of Politics and Public Administration, Qingdao 
      University, Qingdao, Shandong, China.
FAU - Gu, Yuxuan
AU  - Gu Y
AD  - Center for Health Policy Studies, School of Public Health, School of Medicine, 
      Zhejiang University, Hangzhou, Zhejiang, China.
FAU - Dong, Hengjin
AU  - Dong H
AUID- ORCID: 0000-0002-5064-7297
AD  - Center for Health Policy Studies, School of Public Health, School of Medicine, 
      Zhejiang University, Hangzhou, Zhejiang, China. donghj@zju.edu.cn.
LA  - eng
PT  - Journal Article
DEP - 20201203
PL  - England
TA  - BMC Med
JT  - BMC medicine
JID - 101190723
RN  - 0 (Hypoglycemic Agents)
SB  - IM
MH  - Cost-Benefit Analysis/*methods
MH  - Diabetes Mellitus, Type 2/*drug therapy/*economics
MH  - Female
MH  - Humans
MH  - Hypoglycemic Agents/*economics/pharmacology/*therapeutic use
MH  - Male
MH  - Middle Aged
PMC - PMC7713153
OTO - NOTNLM
OT  - Cost-effectiveness
OT  - DPP-4 inhibitor
OT  - GLP-1 receptor agonist
OT  - Glinide
OT  - Insulin
OT  - Metformin
OT  - Sulfonylurea
OT  - Thiazolidinedione
OT  - Type 2 diabetes
OT  - alpha-Glucosidase inhibitor
COIS- None declared.
EDAT- 2020/12/04 06:00
MHDA- 2021/02/12 06:00
PMCR- 2020/12/03
CRDT- 2020/12/03 05:27
PHST- 2020/06/26 00:00 [received]
PHST- 2020/11/02 00:00 [accepted]
PHST- 2020/12/03 05:27 [entrez]
PHST- 2020/12/04 06:00 [pubmed]
PHST- 2021/02/12 06:00 [medline]
PHST- 2020/12/03 00:00 [pmc-release]
AID - 10.1186/s12916-020-01837-x [pii]
AID - 1837 [pii]
AID - 10.1186/s12916-020-01837-x [doi]
PST - epublish
SO  - BMC Med. 2020 Dec 3;18(1):378. doi: 10.1186/s12916-020-01837-x.