Abstract
The IDF global guideline for type-2 DM considers metformin as first-line therapy, without contraindications, but gastrointestinal intolerance occurs in 20-30% of patients receiving an immediate release of metformin, being a possible barrier to treatment adherence. Glucophage® XR is an extended-release formulation of metformin IR, with the same antidiabetic efficacy, a flexible dosing range to assist in treatment titration with superior gastrointestinal tolerability, contributing to greater compliance. The aim of this study is to evaluate the cost-effectiveness (CE) and budget impact (BI) of metformin XR compared to metformin IR, in adults with type-2 DM, from the perspective of the public health system in Brazil. The outcomes of interest were days on treatment; number of events (stroke, myocardial infarction, heart failure, peripheral mononeuropathy, retinopathy, blindness, diabetic foot, amputation, diabetic nephropathy and renal disease); number of full-lifetime-patients without treatment (non-compliance); number of full-lifetime-patients with controlled diabetes; and life years. Efficacy data were obtained from literature review and unit costs were obtained from official price lists. The time horizon of the CE and BI model was 30 and 10 years respectively. A 5% annual discount rate was applied to costs and benefits in the CE model. Glucophage® XR increased overall survival in 0.75 day and assured more 1,631 days on treatment, per patient, during lifetime period. Also, reduced 6,249 events and allowed more 143 full-lifetime-patients with controlled type-2 DM, per 1,000 patients. Glucophage® XR was dominant vs. Metformin IR, resulting in saving approximately 5.5% (BRL 10,961,011 per patient). Additionally, the use of Glucophage® XR in patients with type-2 DM resulted in saving of approximately BRL 3,787,758,740.88 in the period from 2014 to 2025. Glucophage® XR showed dominance versus metformin IR due to a safer profile leading to better tolerance, compliance and better health outcomes.
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