Abstract
BackgroundTo investigate the long-term economic outcome of dapagliflozin versus metformin in Chinese patients with type 2 diabetes mellitus (T2DM) whose diet and exercise have not provided sufficient glycemic control.MethodsAn economic analysis of dapagliflozin versus metformin was conducted by using the Chinese Outcomes Model for T2DM with a time horizon of lifetime, which was developed and validated based on the Chinese population. The efficacy data of lowering HbA1c of dapagliflozin and metformin was derived from a network meta-analysis. Other clinical, cost and utility inputs were obtained from published sources. Lifetime discounted quality-adjusted life-years, cost, and incremental cost-effectiveness ratio were measured. The uncertainty was facilitated by one-way and probabilistic sensitivity analyses.ResultsThe comparison of metformin and dapagliflozin in Chinese patients with insufficient glycemic control by diet and exercise showed that dapagliflozin was more costly and produced fewer health benefits in our simulated cohort. The sensitivity analyses indicated that the results were robust.ConclusionsDapagliflozin is not likely to be cost-effective compared with metformin for Chinese patients with T2DM inadequately controlled with diet and exercise.
Highlights
Model overview This study provides an economic assessment of dapagliflozin monotherapy for type 2 diabetes mellitus (T2DM) patients with inadequate glycemic control on diet and exercise
Base‐case analysis Compared with metformin monotherapy, dapagliflozin was associated with lower life expectancy and lower quality adjusted life expectancy, and an additional cost of $2188; leading to a dominated result
These health detriments in the dapagliflozin treatment arm were driven by the increased cumulative incidence of myocardial infarction (MI), stroke, congestive heart failure (CHF), end-stage renal disease (ESRD), Blindness, clinical neuropathy, minor and major amputation (Table 3)
Summary
Due to population growth and aging, the Global Burden of Disease Study showed that all-age disability-adjusted life-years (DALYs) for diabetes in 2016 were more than 57 million, which increased by 24.4% (95% CI 22.7–26.2) from 1990 to 2016 [1]. The sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new class of oral antidiabetic drugs (OAD) that act by reducing the reabsorption of renal-filtered glucose back into the bloodstream, thereby resulting in loss of glucose in the urine [6] Several drugs in this class, such as dapagliflozin, canagliflozin and empagliflozin, have shown their favorable clinical efficacy [7]. One latest economic report found dapagliflozin treatment was more cost-effective compared with metformin treatment for Chinese type 2 diabetes patients. This findings are largely driven by the effects of favorable weight profile on clinical, utility, and costs in the Cardiff model, which is based on the Western population [11]. To investigate the long-term economic outcome of dapagliflozin versus metformin in Chinese patients with type 2 diabetes mellitus (T2DM) whose diet and exercise have not provided sufficient glycemic control
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