Cost-Minimization Analysis of Linagliptin Compared to Sitagliptin in the Treatment of Type 2 Diabetes Mellitus from a Turkish Healthcare Perspective

Abstract

Objective: The aim of the present study is to evaluate linagliptin and sitagliptin in terms of pharmacoeconomics, by comparing the two dipeptidyl-peptidase 4 inhibitors (DPP-4i) with cost-minimization analysis. Methods: Cost-minimization analysis was used to compare linagliptin and sitagliptin in terms of pharmacoeconomics. In a recent meta-analysis, linagliptin and sitagliptin were reported to have similar effects regarding the reduction in the HbA1c levels achieved at the 24th week of treatment (HbA1c reduction at 24th week: -0.8%). Direct medical costs in Turkey were used for the comparisons. Cost data was constituted from the perspective of the healthcare payer, taking alternative therapies and all possible complications into consideration, and reviewing actual data from a tertiary healthcare center, related literature and clinical guidelines. A model was established with Microsoft Office Excel 2015 software, using the local data specifically from diabetes (DM) patients. Cost analysis was performed for one-year time frame. Results: Average direct annual treatment cost per patient in type 2 diabetes mellitus (T2DM) was € 1,481.4 with linagliptin and € 1,500.1 with sitagliptin. In comparison to sitagliptin, linagliptin is determined to be a cost-saving alternative (- € 18.7). Probabilistic sensitivity analysis with Monte Carlo Simulation showed that linagliptin treatment (95% confidence interval € 1,393.8- € 1,523.9; n=1,000) is 52.9% equal or cost-saving compared to sitagliptin treatment (95% confidence interval € 1,380.5- € 1,509.1; n=1,000). Conclusion: From the healthcare payer's perspective in Turkey regarding treatment of T2DM, linagliptin, a DPP-4 inhibitor, is a cost-saving treatment alternative to sitagliptin, with both having similar effects on HbA1c levels.