Abstract
IntroductionType 2 diabetes mellitus causes a sizable burden globally from both health and economic points of view. This study aimed to assess the budget impact of substituting sitagliptin with liraglutide versus other glucose-lowering drugs from the private health insurance perspective in Egypt over a 3-year time horizon.MethodsTwo budget impact models were compared with the standard of care (metformin, pioglitazone, gliclazide, insulin glargine, repaglinide, and empagliflozin) administered in addition to liraglutide or sitagliptin versus the standard of care with placebo. A gradual market introduction of liraglutide or sitagliptin was assumed, and the existing market shares for the other glucose-lowering drugs were provided and validated by the Expert Panel. The event rates were extracted from the LEADER and TECOS trials. Direct and mortality costs were measured. Sensitivity analyses were performed.ResultsThe estimated target population of 120,574 type 2 diabetic adult patients was associated with cardio vascular risk. The budget impact per patient per month for liraglutide is EGP29 ($6.7), EGP39 ($9), and EGP49 ($11.3) in the 1st, 2nd, and 3rd years, respectively. The budget impact per patient per month for sitagliptin is EGP11 ($2.5), EGP14 ($3.2), and EGP18 ($4.1) in the 1st, 2nd, and 3rd years, respectively. Furthermore, adoption of liraglutide resulted in 203 fewer deaths and 550 avoided hospitalizations, while sitagliptin resulted in 43 increased deaths and 14 avoided hospitalizations. The treatment costs of liraglutide use are mostly offset by substantial savings due to fewer cardiovascular-related events, avoided mortality and avoided hospitalizations over 3 years.ConclusionAdding liraglutide resulted in a modest budget impact, suggesting that the upfront drug costs were offset by budget savings due to fewer cardiovascular-related complications and deaths avoided compared to the standard of care. Sitagliptin resulted in a small budget impact but was associated with increased deaths and fewer hospitalizations avoided.
Highlights
Type 2 diabetes mellitus causes a sizable burden globally from both health and economic points of view
The estimated target population of 120,574 type 2 diabetes mellitus (T2DM) adult patients associated with CV risk in Egypt was modeled in the budget impact analysis to compare treatment with liraglutide and sitagliptin, both in addition to the standard of care
The annual results from the perspective of private health insurers over a 3-year horizon (Figs. 2 and 3) suggest that liraglutide use results in EGP232.5 million ($54 million) budget savings in medical costs, while sitagliptin use results in a budget increase of EGP29 million ($6.7 million) in medical costs due to an increased number of complications associated with sitagliptin
Summary
Type 2 diabetes mellitus causes a sizable burden globally from both health and economic points of view. Diabetes causes a sizable burden globally from both health and economic points of view. Of the current diabetic population, 79% are from low- and middle-income countries, and the highest prevalence is among people aged 40 and 59 [1]. The IDF ranked Egypt as the ninth highest country in the number of type 2 diabetes mellitus (T2DM) patients [2]. The number of T2DM patients has increased threefold over 20 years ago, with a current prevalence of 15.6% among the 20 to 79 age group [2]. T2DM is a metabolic disease associated with microvascular and macrovascular complications. Optimal glucose control is associated with a reduced risk of microvascular complications (retinopathy, nephropathy, and neuropathy) and benefits for macrovascular complications (reduced rates of heart attacks, strokes and improved blood flow to legs) [3]
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