Étude coût-utilité de l’association de la metformine aux différentes classes d’antidiabétiques chez le sujet âgé de plus de 80 ans

Abstract

The elderly diabetes prevalence is greater than 20%. Drug hypoglycemia prevention is the key point in elderly diabetes therapeutic management. Today, there is no better drug to add to metformin in elderly uncontrolled diabetes. A literature review established the different hypoglycemic events and their occurrence probability. After determining the various procedures costs in the hypoglycemic events management and associated treatments costs, the cost of each type of hypoglycemic event (mild, moderate and severe) was calculated and the average cost of an hypoglycemic event (all intensities combined) was deduced. In order to determine the most appropriate drug association in the 80+age group, a cost-utility study was conducted using the quality adjusted life years (QALY) determination of each strategy. The lower hypoglycemic strategies are metformine+DPP-4 inhibitor and metformin+GLP-1 analogs. Following the calculation of the different ICERs, the most economically and clinically advantageous drug combination is: metformin+DPP-4 inhibitor. DISCUSSION-CONCLUSION: Based on this study, the drug combination metformin+DPP-4 inhibitor would be the better therapy in elderly diabetic patient. However, this result needs to be adapted individually.