The cost-effectiveness of exenatide once weekly compared with exenatide twice daily and insulin glargine for the treatment of patients with type two diabetes and body mass index ≥30 kg/m²in Spain

May 11, 2013Journal of medical economics

Cost-effectiveness of weekly exenatide versus twice-daily exenatide and insulin glargine for treating adults with type 2 diabetes and obesity in Spain

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Abstract

Exenatide once weekly (EQW) is associated with a cost-effectiveness ratio of €12,084 per QALY gained compared to insulin glargine (IG) for treating type two diabetes mellitus (T2DM) in Spain.

EQW was found to be less costly and more effective than exenatide twice daily (EBID).
The analysis projected clinical and economic outcomes over a 35-year time horizon.
The cost-effectiveness assessment was based on patients with a BMI greater than 30 kg/m².
Sensitivity analyses suggested that the results were robust under various scenarios.
Common limitations included the extrapolation of short-term clinical data over the long time horizon.

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OBJECTIVE: The objective of this analysis was to estimate the cost-effectiveness of exenatide once weekly (EQW) for the treatment of type two diabetes mellitus (T2DM) in Spain. EQW was compared against exenatide twice daily (EBID) and insulin glargine (IG).

METHODS: The IMS CORE Diabetes Model was used to project clinical and economic outcomes for patients with T2DM treated with EQW, EBID, and IG. Treatment effects and patient baseline characteristics were taken from the DURATION 3 and pooled DURATION 1 and 5 studies, in the comparison against IG and EBID, respectively. Unit costs and health state utility values were derived from published sources. To reflect diabetes progression, patients started on EQW or EBID, switching to insulin glargine after 3 years. The analysis was conducted from the perspective of the Spanish National Health Service over a time horizon of 35 years with costs and outcomes discounted at 3%. The base case included patients with a BMI > 30 kg/m(2), which is in line with current prescription restrictions in Spain. Uncertainty was addressed through extensive one-way sensitivity analyses around key model parameters and a comprehensive probabilistic sensitivity analysis.

RESULTS: When compared with EBID, EQW was the dominant strategy, i.e., less costly and more effective. When compared to IG, the incremental cost-effectiveness ratio was estimated at €12,084 per QALY gained. Sensitivity analysis indicated that the model projections were robust to the various scenarios tested.

LIMITATIONS: Primary limitations of the analysis are common to other T2DM analyses and include the extrapolation of short-term clinical data to the 35 year time horizon and uncertainty around optimum treatment durations.

CONCLUSION: The analyses indicate that EQW is a cost-effective option for the treatment of T2DM patients in Spain for patients with a BMI > 30 kg/m(2) considering a willingness-to-pay threshold of €30,000 per QALY gained.

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The cost-effectiveness of exenatide once weekly compared with exenatide twice daily and insulin glargine for the treatment of patients with type two diabetes and body mass index ≥30 kg/m²in Spain

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