Cost-utility analysis of liraglutide compared with sulphonylurea or sitagliptin, all as add-on to metformin monotherapy in Type2 diabetes mellitus

摘要

Aim To investigate the cost-effectiveness of liraglutide as add-on to metformin vs. glimepiride or sitagliptin in patients with Type2 diabetes uncontrolled with first-line metformin. Methods Data were sourced from a clinical trial comparing liraglutide vs. glimepiride, both in combination with metformin, and a clinical trial comparing liraglutide vs. sitagliptin, both as add-on to metformin. Only the subgroup of patients in whom liraglutide was added to metformin monotherapy was included in the cost-utility analysis. The CORE Diabetes Model was used to simulate outcomes and costs with liraglutide 1.2 and 1.8mg vs. glimepiride and vs. sitagliptin over patients' lifetimes. Treatment effects were taken directly from the trials. Costs and outcomes were discounted at 3.5% per annum and costs were accounted from a third-party payer (UK National Health System) perspective. Results Treatment with liraglutide 1.2 and 1.8mg resulted, respectively, in mean increases in quality-adjusted life expectancy of 0.32±0.15 and 0.28±0.14 quality-adjusted life years vs. glimepiride, and 0.19±0.15 and 0.31±0.15 quality-adjusted life years vs. sitagliptin, and was associated with higher costs of ￡3003±￡678 and ￡4688±￡639 vs. glimepiride, and ￡1842±￡751 and ￡3224±￡683 vs. sitagliptin, over a patient's lifetime. Both liraglutide doses were cost-effective, with incremental cost-effectiveness ratios of ￡9449 and ￡16501 per quality-adjusted life year gained vs. glimepiride, and ￡9851 and ￡10465 per quality-adjusted life year gained vs. sitagliptin, respectively. Conclusions Liraglutide, added to metformin monotherapy, is a cost-effective option for the treatment of Type2 diabetes in a UK setting.