Long-term cost-utility analysis of exenatide once weekly versus insulin glargine for the treatment of type 2 diabetes patients in the US

Abstract

Objective:

The purpose of this study was to estimate the long-term cost-utility of treating type 2 diabetes mellitus (T2DM) patients with exenatide once weekly (EQW) compared with insulin glargine (IG) from a US payer perspective.

Methods:

A validated computer simulation model, the CORE Diabetes Model, was used to project lifetime clinical outcomes and direct medical costs. Direct medical costs included pharmacy costs and costs associated with the management of diabetes and its complications. The model was populated using patient characteristics (mean age: 57.9 years; mean diabetes duration: 7.9 years; mean HbA1_c: 8.3%; mean body mass index [BMI]: 32.3 kg/m²) and clinical data from a phase 3 clinical trial that compared EQW with IG in T2DM patients on a background of metformin alone or a combination of metformin and a sulphonylurea (DURATION-3). All EQW patients were assumed to have stayed on treatment for 3 years before switching to IG. Health outcomes and costs were discounted at 3% per year. Complication costs were derived from published sources. A range of sensitivity analyses was performed.

Results:

Over a lifetime horizon, and compared with IG, EQW was associated with an incremental cost of $3914 (SD = 2923). EQW was projected to increase life expectancy by 0.135 (SD = 0.216) years and to improve quality-adjusted life expectancy by 0.246 (SD = 0.147) quality-adjusted life years (QALYs), generating an incremental cost-effectiveness ratio (ICER) of $15,936/QALY. Assuming a payer’s willingness to pay threshold of $50,000/QALY, EQW is therefore cost-effective compared to IG. One-way and probabilistic sensitivity analyses confirmed EQW’s cost-effective profile.

Limitations:

Short-term changes (26 weeks) in surrogate end-points (e.g., HbA1_c, weight, complications) from one clinical trial were used to project long-term future effects on clinical outcomes.

Conclusions:

Treatment with EQW is projected to be cost-effective compared to treatment with IG.

Keywords::

• Exenatide
• Insulin glargine
• Cost-utility
• Modeling
• Type 2 diabetes
• United States
• Costs
• Cost-effectiveness

Transparency

Declaration of funding

The funding for the study and manuscript preparation was provided by Amylin Pharmaceuticals, Inc., USA.

Declaration of financial/other relationships

The sponsor had no decisive role in the conduct of the cost-consequence analysis. The sponsor did provide editorial assistance for the manuscript. Although results, interpretations, and conclusions were not dictated by the sponsor, the paper did receive sponsor approval prior to submission. Two of the authors (JHB, SCB) are employees of Amylin who sponsored the preparation of the manuscript. The other authors (AL, A-L G, and YS) are employees of IMS Health and have no relationship (financial, employment, other significant/relevant relationships) with the sponsor.