Cost-effectiveness of add-on treatments to metformin in a Swedish setting: liraglutide vs sulphonylurea or sitagplitin

Figures & data

Table 1. Baseline characteristics using liraglutide 1.2 mg group in LEAD-25 and the liraglutide 1.2 mg group in 1860-LIRA-DPP-48.

Characteristic	Value at baseline
	LEAD-2	1860-LIRA-DPP-4
Baseline age (years)	57	56
Baseline duration of diabetes (years)	7	6
Glycated hemoglobin (HbA1c, %)	8.30	8.4
Systolic blood pressure (SBP, mmHg)	132	131.2
Diastolic blood pressure (DBP, mmHg)	80	80.3
Total cholesterol (TC, mmol/L)	4.88^a	4.88^a
Low density lipoprotein (LDL, mmol/L)	3.11^a	3.11^a
High density lipoprotein (HDL, mmol/L)	1.29^a	1.29^a
Triglycerides (mmol/L)	2.19^a	2.19^a
Body mass index (BMI, kg/m^2)	31.1	32.6

^aNot reported in Nauck et al.5 and Pratley et al.8, respectively. The baseline blood lipid values were adopted from Davies et al.14.

Table 2. Treatment effects from clinical trials and assumptions applied in the model based analysis.

Risk factor	Liraglutide vs glimepiride		Liraglutide vs sitagliptin
	Liraglutide 1.2 mg + metformin	Sulphonylurea + metformin	Liraglutide 1.2 mg + metformin	Sitagliptin 100 mg + metformin
Glycated hemoglobin (HbA1c, %)
Change in first cycle	−1.09	−1.12	−1.29	−0.88
Change in subsequent cycles (drift)	0.27	0.33	0.27	0.27
Systolic blood pressure (mmHg)	−1.25	0.15	−0.37	−1.03
Total cholesterol (mmol/L)	0.05	0.04	−0.01	0.03
Low density lipoprotein (mmol/L)	−0.09	−0.06	0.17	0.17
High density lipoprotein (mmol/L)	−0.02	−0.03	0.09	0.01
Triglycerides (mmol/L)	−0.07	0.03	−0.1	−0.23
Body mass index (BMI, kg/m^2)
Change in first cycle	−0.91	0	−0.97	−0.41
Change in subsequent cycles (drift)	−0.09	0.12	−0.09	0

Table 3. Base case analysis liraglutide 1.2 mg vs SU as add-on to metformin. Results by gender and smoking status. Discounted QALYs and discounted costs in SEK 2013.

	Liraglutide	SU	Increment liraglutide vs sulphonylurea
Men, non–smokers
Health gains
Survival after 40 years* (%)	0.6	0.5	0.1
Life years	13.89	13.77	0.12
Quality-adjusted life years (QALY)	10.30	9.94	0.36
Costs
Direct cost	571,999	515,195	56,805
Production loss**	29,652	30,705	−1053
Net consumption***	855,508	830,901	24,607
Total cost	1,457,159	1,376,801	80,358
ICER	Costs per QALY for liraglutide vs SU 226,047
Men, smokers
Health gains
Survival after 40 years* (%)	0.1	0	0
Life years	11.95	11.84	0.11
Quality-djusted life years (QALY)	9.06	8.75	0.31
Costs
Direct cost	470,986	411,697	59,289
Production loss**	38,066	39,293	−1227
Net consumption***	527,268	508,096	19,173
Total cost	1,036,321	959,086	77,234
ICER	Costs per QALY for liraglutide vs SU 250,557
Women, non-smokers
Health gains
Survival after 40 years* (%)	0.7	0.6	0.1
Life years	14.33	14.20	0.13
Quality-adjusted life years (QALY)	9.32	8.96	0.36
Costs
Direct cost	556,786	499,931	56,855
Production loss**	27,606	28,632	−1026
Net consumption***	923,616	896,993	26,623
Total cost	1,508,008	1,425,556	82,452
ICER	Costs per QALY for liraglutide vs SU 230,416
Women, smokers
Health gains
Survival after 40 years* (%)	0.1	0.1	0
Life years	12.50	12.38	0.12
Quality adjusted life years (QALY)	8.32	8.00	0.32
Costs
Direct cost	473,492	413,601	59,891
Production loss**	35,629	36,822	−1193
Net consumption***	607,501	585,634	21,867
Total cost	1,116,622	1,036,056	80,566
ICER	Costs per QALY for liraglutide vs SU 255,121

*Not discounted.

**Production loss due to hypoglycemia and diabetic complications.

***Net consumption = (consumption − production) * survival.

Table 4. Base case analysis liraglutide 1.2 mg vs sitagliptin as an add-on to metformin. Results by gender and smoking status. Discounted QALYs and discounted costs in SEK 2013.

	Liraglutide	Sitagliptin	Increment liraglutide vs sitagliptin
Men, non–smokers
Health gains
Survival after 40 years* (%)	0.8	0.7	0.1
Life years	14.24	14.13	0.11
Quality adjusted life years (QALY)	10.53	10.15	0.38
Costs
Direct cost	597,102	559,590	37,512
Production loss**	33,527	35,524	−1997
Net consumption***	730,086	708,978	21,108
Total cost	1,360,715	1,304,092	56,624
ICER	Costs per QALY for liraglutide vs sitagliptin 148,766
Men, smokers
Health gains
Survival after 40 years* (%)	0.1	0.1	0
Life years	12.32	12.23	0.09
Quality adjusted life years (QALY)	9.32	8.99	0.33
Costs
Direct cost	492,662	454,024	38,638
Production loss**	42,771	45,123	−2352
Net consumption***	417,215	401,604	15,611
Total cost	952,648	900,750	51,898
ICER	Costs per QALY for liraglutide vs sitagliptin 156,900
Women, non-smokers
Health gains
Survival after 40 years* (%)	0.9	0.8	0.1
Life years	14.68	14.57	0.11
Quality adjusted life years (QALY)	9.52	9.14	0.38
Costs
Direct cost	583,618	546,351	37,267
Production loss**	31,169	33,105	−1936
Net consumption***	796,227	773,955	22,272
Total cost	1,411,014	1,353,411	57,603
ICER	Costs per QALY for liraglutide vs sitagliptin 150,411
Women, smokers
Health gains
Survival after 40 years* (%)	0.1	0.1	0
Life years	12.88	12.78	0.10
Quality adjusted life years (QALY)	8.55	8.21	0.34
Costs
Direct cost	496,452	457,341	39,110
Production loss**	39,961	42,230	−2269
Net consumption***	494,277	476,707	17,570
Total cost	1,030,689	976,278	54,411
ICER	Costs per QALY for liraglutide vs sitagliptin 160,827

*Not discounted.

**Production loss due to hypoglycemia and diabetic complications.

***Net consumption = (consumption − production) * survival.

Table 5. Base case analysis liraglutide 1.2 mg vs SU as an add-on to metformin. Results for non-smoking men. Discounted costs in SEK 2013 by source of cost.

	Liraglutide	SU	Increment liraglutide vs sulphonylurea
Background cost	18,070	17,915	155
Diabetic treatment
Pharmaceutical	139,440	68,799	70,641
Hypoglycemia	703	852	−149
Other treatments
Blood pressure	10,736	10,644	92
Blood lipids	29,764	29,509	255
Microvascular complications
Retinopathy	18,142	19,795	−1654
Neuropathy	74,606	74,799	−194
Nephropathy	82,925	88,624	−5699
Macrovascular complications
IHD	27,748	28,576	−827
MI	22,386	23,025	−639
Stroke	118,623	120,801	−2178
CHF	28,855	31,855	−3000
Direct cost	571,999	515,195	56,805
Production loss*	29,652	30,705	−1053
Net consumption**	855,508	830,901	24,607
Total cost	1,457,159	1,376,801	80,358

*Production loss due to hypoglycemia and diabetic complications.

**Net consumption = (consumption − production) * survival.

IHD, ischemic heart disease; MI, myocardial infarction; CHF, congestive heart failure.

Table 6. Base case analysis liraglutide 1.2 mg vs sitagliptin as an add-on to metformin. Results for non-smoking men. Discounted costs in SEK 2013 by source of cost.

	Liraglutide	Sitagliptin	Increment liraglutide vs sitagliptin
Background cost	18,523	18,386	138
Diabetic treatment
Pharmaceutical	147,082	98,436	48,646
Hypoglycemia	632	752	−120
Other treatments
Blood pressure	11,006	10,539	466
Blood lipids	30,512	30,285	227
Microvascular complications
Retinopathy	20,258	22,059	−1801
Neuropathy	77,917	78,459	−542
Nephropathy	93,570	97,159	−3589
Macrovascular complications
IHD	27,706	28,913	−1207
MI	22,314	22,941	−627
Stroke	117,869	118,149	−280
CHF	29,713	33,513	−3800
Direct cost	597,102	559,590	37,512
Production loss*	33,527	35,524	−1997
Net consumption**	730,086	708,978	21,108
Total cost	1,360,715	1,304,092	56,624

*Production loss due to hypoglycemia and diabetic complications.

**Net consumption = (consumption − production) * survival.

IHD, ischemic heart disease; MI, myocardial infarction; CHF, congestive heart failure.

Table 7. Three sensitivity analyses for liraglutide 1.2 mg vs SU as an add-on to metformin. Discounted life years, QALYs and costs in SEK. Results for non-smoking men.

	Liraglutide	SU	Increment liraglutide vs sulphonylurea
Hypoglycemia frequency when on insulin treatment following Ostenson et al.28
Life years	13.89	13.77	0.12
Quality-adjusted life year, QALY	10.03	9.66	0.38
Direct cost	575,070	518,507	56,563
Production loss	34,429	35,858	−1429
Net consumption**	855,508	830,901	24,607
Total cost	1,465,007	1,385,265	79,741
ICER	Costs per QALY gained for liraglutide vs SU: SEK 212,059
Earlier initation of second-line treatment
Life years	14.07	13.93	0.14
Quality-adjusted life year, QALY	10.78	10.32	0.46
Direct cost	551,508	463,947	87,560
Production loss	26,178	27,399	−1221
Net consumption**	893,645	862,791	30,854
Total cost	1,471,332	1,354,138	117,193
ICER	Costs per QALY gained for liraglutide vs SU: SEK 254,009
Initial BMI = 35 instead of trial mean value
Life years	13.8	13.68	0.12
Quality-adjusted life year, QALY	9.9	9.54	0.36
Direct cost	571,419	514,328	57,091
Production loss	29,688	30,744	−1056
Net consumption**	837,737	812,617	25,121
Total cost	1,438,844	1,357,689	81,155
ICER	Costs per QALY gained for liraglutide vs SU: SEK 226,817

Table 8. Three sensitivity analyses for liraglutide 1.2 mg vs sitagliptin as an add-on to metformin. Discounted life years, QALYs and costs in SEK. Results for non-smoking men.

	Liraglutide	Sitagliptin	Increment liraglutide vs sitagliptin
Hypoglycemia frequency when on insulin treatment following Ostenson et al.28
Life years	14.24	14.13	0.11
Quality-adjusted life year, QALY	10.3	9.87	0.42
Direct cost	599,853	562,849	37,004
Production loss	37,807	40,594	−2787
Net consumption**	730,086	708,978	21,108
Total cost	1,367,746	1,312,421	55,325
ICER	Costs per QALY gained for liraglutide vs sitagliptin: SEK 130,540
Earlier initation of second-line treatment
Life years	14.49	14.35	0.14
Quality-adjusted life year, QALY	11.01	10.64	0.37
Direct cost	549,750	506,105	43,645
Production loss	29,420	30,577	−1157
Net consumption**	781,347	751,959	29,388
Total cost	1,360,517	1,288,641	71,877
ICER	Costs per QALY gained for liraglutide vs sitagliptin: SEK 195,708
Initial BMI = 35 instead of trial mean value
Life years	14.18	14.08	0.11
Quality-adjusted life year, QALY	10.29	9.9	0.39
Direct cost	596,448	558,817	37,631
Production loss	33,552	35,550	−1998
Net consumption**	719,395	697,796	21,599
Total cost	1,349,395	1,292,163	57 232
ICER	Costs per QALY gained for liraglutide vs sitagliptin: SEK 147,036

Figure 1. Cost-effectiveness plane for liraglutide 1.2 mg vs sulphonylurea as an add-on to metformin. PSA with 500 simulations. Base case, 3% discount rate.

Figure 2. Cost-effectiveness acceptability curve of liraglutide 1.2 mg vs sulphonylurea. PSA with 500 simulations. Base case, 3% discount rate.

Figure 3. Cost-effectiveness plane for liraglutide 1.2 mg vs sitagliptin 100 mg as an add-on to metformin. PSA with 500 simulations. Base case, 3% discount rate.

Figure 4. Cost-effectiveness acceptability curve of liraglutide 1.2 mg vs sitagliptin 100 mg. PSA with 500 simulations. Base case, 3% discount rate.

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