Cost-effectiveness analysis of exenatide twice daily (BID) vs insulin glargine once daily (QD) as add-on therapy in Chinese patients with Type 2 diabetes mellitus inadequately controlled by oral therapies

Abstract

Objective:

To estimate cost-effectiveness of exenatide twice daily (BID) vs insulin glargine once daily (QD) as add-on therapy in Chinese type 2 diabetes patients not well controlled by oral anti-diabetic (OAD) agents.

Methods:

The Cardiff model was populated with data synthesized from three head-to-head randomized clinical trials of up to 30 weeks in China comparing exenatide BID vs insulin glargine as add-on therapies to oral therapies in the Chinese population. The Cardiff model generated outputs including macrovascular and microvascular complications, diabetes-specific mortality, costs, and quality-adjusted life years (QALYs). Cost and QALYs were estimated with a time horizon of 40 years at a discount rate of 3% from a societal perspective.

Results:

Compared with insulin glargine plus OAD treatments, patients on exenatide BID plus OAD gained 1.88 QALYs, at an incremental cost saving of Chinese Renminbi (RMB) 114,593 (i.e., cost saving of RMB 61078/QALY). The cost-effectiveness results were robust to various sensitivity analyses including probabilistic sensitivity analysis. The variables with the most impact on incremental cost-effectiveness ratio included HbA1c level at baseline, health utilities decrement, and BMI at baseline.

Conclusions:

Compared with insulin glargine QD, exenatide BID as add-on therapy to OAD is a cost-effective treatment in Chinese patients inadequately controlled by OAD treatments.

Keywords::

• Cost-effectiveness
• Insulin glargine
• Exenatide
• Type 2 diabetes mellitus (T2DM)
• Cardiff model

Transparency

Declaration of funding

There are no funding sources reported for this manuscript.

Declaration of financial/other relationships

No potential conflicts of interest relevant to this article were reported. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors thank Xuemei Zhen and Yuhang Zeng (Zhejiang University School of Public Health, Hangzhou, China) for their help in collecting data.