PDB65 - THE COST-EFFECTIVENESS OF METFORMIN IN PRE-DIABETICS: A SYSTEMATIC LITERATURE REVIEW OF HEALTH ECONOMIC EVALUATIONS

Abstract

We aimed to systematically identify and appraise cost-effectiveness studies of metformin in high-risk prediabetic subjects. A systematic literature review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The search was conducted via different bibliographic databases: PubMed, Embase, ISPOR presentation database as well as the CEA and CRD registries. All cost-effectiveness studies assessing metformin in prediabetic patients were included. We extracted study identification items, interventions, and target population, model design & reported outcomes. The quality of the included studies was assessed using a published critical appraisal checklist for published economic evaluation. After the full-text screening, 16 English-language reports (13 full-text studies and 3 abstracts) fulfilled the eligibility criteria and were included in a qualitative analysis. All models investigated the clinical and economic value of the immediate-release metformin formulation evaluated during the Diabetes Prevention Program (DPP) study. Although, in the long term, metformin appears to be more expensive than ILC in terms of direct medical costs, when the indirect non-medical costs of an ILC intervention are included, metformin becomes less expensive than ILC. One study reported that for patients with high BMI (higher than 30 kg/m2), metformin is the most cost-effective strategy compared to placebo and ILC and was shown to increase life expectancy relative to other interventions. The retrieved economic models add greater weight to the clinical evidence supporting the use of intensive lifestyle intervention and metformin for preventing T2DM. In the context of the growing prevalence of diabetes, cost-effective prevention becomes increasingly relevant. Metformin is cost-saving in the short- to medium-term and possibly in the long-term, due to high costs of implementing and maintaining an ILC program. The evidence in favor of metformin in relevant subgroups should be explored in future economic evaluations.