Cost-effectiveness of dapagliflozin compared to DPP-4 inhibitors as combination therapy with metformin in the treatment of type 2 diabetes mellitus without established cardiovascular disease in Colombia

ABSTRACT

Introduction

SGLT2 inhibitors or DPP-4 inhibitors are among the preferred options in patients with type 2 diabetes mellitus (T2DM) without established cardiovascular disease.

Objective

To evaluate the incremental cost-effectiveness of dapagliflozin versus DPP-4 inhibitors as a complement to metformin in the treatment ofT2D, from the perspective of the Colombian health system.

Methods

The Cardiff model was used to estimate the incremental cost-effectiveness ratio (ICER) of dapagliflozin plus metformin compared to DPP-4 inhibitors plus metformin in adults with T2DM who did not respond adequately to metformin monotherapy. We estimated the incidence of micro- and macrovascular complications from risk equations incorporating the effect of treatment. The time horizon for analysis was 5 years and a discount rate of 5% was applied, for both costs and outcomes. The costs were expressed in 2020 USD (1 USD = $3,693.36 COP).

Results

Dapagliflozin in association with metformin resulted in a higher number of quality-adjusted life years (QALYs) compared to the intervention. The ICER was US$1,964.80 per QALY gained.

Conclusion

From the point of view of Colombian healthcare system, the combination of dapagliflozin with metformin is a cost-effective option compared to DPP-4 + metformin inhibitors in the treatment of T2D without established cardiovascular disease.

KEYWORDS:

• Cost-effectiveness
• dapagliflozin
• DPP-4 inhibitors
• metformin
• type 2 diabetes

Declaration of interest

P Lasalvia and Y Gil-Rojas were employed at NeuroEconomix during this study. A García Peña received consultant fees from NeuroEconomix during this study. NeuroEconomix received funding from Astra Zeneca Colombia. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Y Gil-Rojas and P Lasalvia participated in design of the work, data acquisition, analysis, interpretation of data, manuscript drafting and final approval of the version to be published. A García Peña participated in design of the work, manuscript drafting and final approval of the version to be published. All authors agree for the final version of the manuscript to be published.

Key points

• The benefits and related costs of new health technologies or management strategies for T2D should be considered with the aim of controlling glycemia in the short term, as well as reducing the incidence and consequently the costs of microvascular and macrovascular complications derived from the pathology in the medium and long term.

• The objective of this analysis was to evaluate the incremental cost-effectiveness of dapagliflozin versus DPP-4 inhibitors as a complement to metformin in the treatment of T2D, from the perspective of the Colombian health system.

• The results of this study suggest that the intervention with dapagliflozin in combination with metformin results in an increase in QALY related to a reduction in micro- and macrovascular complications, including hospitalizations for heart failure.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was funded by AstraZeneca Colombia.