PDB4: COST-EFFECTIVENESS AND CARDIOVASCULAR RISK—AN ANALYSIS OF ROSIGLITAZONE COMPARED WITH OTHER ORAL HYPOGLYCEMIC AGENTS IN THE TREATMENT OF TYPE 2 DIABETES MELLITUS

Abstract

BACKGROUND: Avandia (rosiglitazone) is a novel insulin sensitizing agent. Compared with traditional therapies for type 2 diabetes mellitus (T2DM), it is as efficacious in lowering glycemic parameters with the additional benefit of improving insulin resistance (IR); both of these are linked to increased risk of cardiovascular (CV) events. An evaluation was conducted from a government payer perspective to explore the potential cost-effectiveness of Avandia compared with less costly generic agents, glyburide and metformin. METHODS: A Markov model was used to calculate direct medical costs and expected survival. The discount rate was 5%. Long-term outcomes were modeled based on clinical and epidemiologic studies and the 10 year UKPDS data. Costs were obtained from the manufacturer, literature, case costing and provincial sources. The base case analysis considered a 70 y.o. male with T2DM with a risk factor profile representative of the UKPDS cohort. Further analyses of patients with other combinations of CV co-morbidity were conducted to examine the range of cost-effectiveness. RESULTS: Avandia, compared to glyburide and metformin, is a potentially attractive option. In the base case Avandia was associated with the highest expected cost but also the greatest survival ($7,781 and 6.254 years); metformin the lowest cost ($3,655) and intermediate survival (6.181 years); glyburide was dominated by metformin ($3,667 and 6.1608 years); the incremental CE ratios for Avandia were $56,888 and $44,237 per LY gained vs. metformin and glyburide respectively. For patients with other clusters of risk factors, the CE ratios ranged from $6,886/LYG (4 additional CV risk factors) up to $59,947/LYG (0 additional risks). The sensitivity analyses showed that the base case results were robust. CONCLUSIONS: While acknowledging the limitations of modeling techniques, the results of this analysis suggest that Avandia, which addresses both dysglycemia and IR, may be a cost-effective alternative for T2DM compared to the conventional therapies.