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

Figures & data

Table 1. Baseline demographics and risk factors.

	Mean	SE	References
Baseline demographics
Baseline age (years)	51.74	0.66	32–34
Proportion of female (%)	51%		53
Duration of diabetes (years)	4.1	0.06	32–34
Height (cm)	164		54
Proportion smokers (%)	18%	0.00	53
Modifiable risk factors†
HbA1c (%)	8.39	0.07	32–34
Total-cholesterol (mmol/L)	6.5	0.14	34
HDL cholesterol (mmol/L)	0.95	0.05	34
SBP (mmHg)	131.7	0.00	3
Weight (kg)*	78.11	0.55	32–34^,54

*HbA1c, glycosylated hemoglobin A1c; HDL, high-density lipoprotein; SBP, systolic blood pressure.

†Weight was calculated from baseline BMI by assuming that average height was 1.64 m calculated from a survey, weight = BMI*height*height.

Table 2. Clinical efficacy and adverse events in 30 weeks based on literature review and meta-analysis.

Variable*	Exenatide BID + OAD	Glargine QD + OAD	Reference
HbA1c change, year 1, %	−1.42 (0.13)	−1.25 (0.12)	32–34
HDL cholesterol change, mmol/l	−0.4 (0.13)	−0.4 (0.09)	34
Weight change, kg	−7.95 (0.99)	1.71 (0.98)	32–34
Number of symptomatic hypoglycemia (frequency‡)	0.1116 (0.035)	0.1763 (0.041)	33^,34^,40
Probability of severe hypoglycemia (probability‡)	0.0015 (0.0043)	0.0027 (0.0055)	33^,34^,40
Gastrointestinal adverse reaction	0.50	0.05	2^,3

*Values are calculated as means and SEs following the normal distribution.

†HbA1c = glycosylated hemoglobin A1c; OAD = oral anti-diabetic agents SE = standard error.

‡Calculated as

Table 3. Annual treatment costs for study drugs.

Drug	Specification	Highest retail price	Daily dose	Annual treatment cost	Annual metformin cost	Annual total cost
Exenatide	0.25 mg/ml, 1.2 ml/pack	¥1566/pack41	5 µg/injection, twice/day	¥22,291*	¥1578†	¥23,869
BID	0.25 mg/ml, 2.4 ml/pack	¥1885/pack41	10 µg/injection, twice/day
Insulin Glargine QD	300U/3 ml/pack	¥237/pack42	15U/day1	¥4325.25‡		¥5903.25

*All the cycles follow the same treatment regime: 5 µg/injection, twice/day for the first month; 10 µg/injection, twice/day for the remaining 11 months of a whole year. One pack contains 60 injections. The annual cost of exenatide = 1566 + 1885 * 11 = RMB 22,291.

†The cost for metformin is ¥366.9 per 12 weeks, and thus the cost of metformin = 366.9 × 4 = 1467.6 = RMB 1468. Convert to 2014 using CPI from 2013 to 2014, annual cost of metformin = 1468 * 105.4/100 * 102.6/100 = RMB 1578. The cost of metformin was used to estimate the cost for oral anti-diabetic agents.

‡Assuming 15U/day for a whole year, the total dose is 15U * 365 = 5340U/year. A whole pack contains 300U and costs RMB 237. Therefore, the annual cost of glargine is 5340U/300U * RMB 237 = RMB 4325.25. The cost of consumables was not included (i.e., test strips, needles, lancets).

Table 4. Annual direct medical costs for diabetes-related complications and severe hypoglycemia (2014¥).

Event	Fatal		Non-fatal		Maintenance		Reference
	Mean	SE	Mean	SE	Mean	SE
Ischemic heart disease	–	0	39,041.39	0	6969.85	0	44
Myocardial infarction	46,547.02	0	46,547.02	0	10,692.45	0	44
Congestive heart failure	15,479.64	0	15,479.64	0	9409.36	0	44
Stroke	14,059.41	0	18,141.13	0	8169.26	0	44
Blind	–	–	12,047.60	0	9297.78	0	44
End-stage renal disease	–	–	114,640.49	0	91,981.79	0	44
Amputation	18,232.95	0	18,232.95	0	14,533.60	0	44
Ulcer	0	0	13,989.07	443.2	4923.52	0	55^,56
Severe hypoglycemia			3829.96				57

SE, standard error.

Table 5. Health utility decrements used in base case analysis.

Event	Health utility decrements
	First year	Subsequent year	Reference
Ischemic heart disease	0.09	0.09	46
Myocardial infarction	0.055	0.055	46
Congestive heart failure	0.108	0.108	46
Stroke	0.164	0.164	46
Blindness	0.074	0.074	50
End stage renal disease	0.263	0.263	50
Amputation	0.28	0.28	46
Gastrointestinal adverse reaction	0.04	NA	35
Severe hypoglycemia	0.047	NA	40
Symptomatic hypoglycemia	0.0142	NA	40
BMI (per unit increase)	0.0472	NA	37^,58
BMI (per unit decrease)	0.0171	NA	37^,58

BMI, body mass index.

Figure 1. Simulated progression of HbA1c in exenatide BID + OAD (treatment arm) and insulin glargine QD + OAD (control arm) over the time horizon 40 years with a treatment escalation threshold of HbA1c ≥7.5%.

Figure 2. Simulated progression of weight in exenatide BID + OAD (treatment arm) and Insulin glargine QD + OAD (control arm) over the modeled time horizon.

Table 6. Module output results for exenatide BID + OAD compared to insulin glargine QD + OAD.

	Insulin Glargine QD + OAD		Exenatide BID + OAD		Difference	Total costs (¥)†	Insulin Glargine QD + OAD	Exenatide BID + OAD
Total events predicted†
Macrovascular	Non-fatal	Fatal	Non-fatal	Fatal		Macrovascular
IHD	179.0	0.0	178.6	0.0	−0.4	IHD	14,689,002	14,619,490
MI	175.8	188.7	175.2	188.4	−0.9	MI	25,039,132	24,927,056
CHF	59.8	5.8	59.8	5.8	0.0	CHF	3,227,545	3,224,406
Stroke	67.0	16.3	66.7	16.2	−0.3	Stroke	4,282,182	4,262,088
Microvascular						Microvascular
Blindness	53.2	0.0	53.0	0.0	−0.3	Blindness	3,481,454	3,450,348
Nephropathy	24.4	2.5	24.3	2.4	−0.1	Nephropathy	9,621,942	9,609,044
Amputation	37.5	3.8	37.4	3.8	−0.1	Amputation	2,604,484	2,581,105
						Hypoglycemia	1,219,127	1,216,112
						Treatment*	66,230,332	77,245,179
						BMI costs	250,169,538	124,837,331
						Total	380,564,737	265,972,161
Cost-Effectiveness Per patient
Discounted cost	¥380,564.74		¥265,972.16		−114,593
Discounted QALYs	11.60		13.48		1.88
Discounted LY	15.37		15.38		0.01
Cost per QALY					−61,078
Cost per LY					−11,923,901

*Treatment cost includes insulin therapy and rescue therapy with insulin drug costs.

†Analysis based on 1000 runs (simulations) for 1000 patients.

IHD, Ischemic Heart Disease; MI, Myocardial Infarction; CHF, Congestive heart Failure; QALYs, Quality adjusted life years; LY, Life Year.

Figure 3. Results of one way sensitivity analysis of input variables, costs, and utilities.

Table 7. One-way sensitivity analysis on selected variables for exenatide BID + OAD vs glargine QD + OAD in China*.

	Difference in QALY	Difference in cost (¥)	ICER (¥)
Health utility decrement (first and subsequent years) per unit BMI gain reduced to 75% (0.0354)	1.50	−114,593	−76,274
Health utility decrement (first and subsequent years) per unit BMI gain halved (0.0236)	1.13	−114,593	−101,535
HbA1c threshold for therapy escalation (8%)	1.70	−21,784	−12,811
Cost of hypoglycemia 50% lower	1.88	−114,591	−61,077
Cost of hypoglycemia 200% higher	1.88	−114,596	−61,080
All event costs (Alternative costs applied)	1.88	−114,582	−61,072
BMI cost halved	1.88	−51,926	−27,677
BMI cost 75% decrease	1.88	−20,593	−10,976
BMI cost zero	1.88	10,740	5724
Discount rate (5%)	1.53	−93,074	−60,895
Base case analysis	1.88	−114,593	−61,078

*Results of QALY, Cost, and ICER were presented per patient.

QALY, Quality-Adjusted Life Year; ICER, Incremental Cost Effectiveness Ratio.

Figure 4. Scatter plot of ICERs for exenatide BID + OAD vs Insulin glargine QD + OAD. BID, twice daily; OAD, oral anti-diabetic agents; QD, once daily.

Figure 5. Cost effectiveness acceptability curve for exenatide BID + OAD vs Insulin glargine QD + OAD. BID, twice daily; OAD, oral anti-diabetic agents; QD, once daily.

Table A1. Detailed parameter values for the three extracted clinical trials.

Article 1
Article title		Effects of exenatide on glycemic control over 52 weeks in patients with type 2 diabetes
Authors		Xian S, Ting-qi Z
Publication year		2014
Study drugs		Exenatide BID + OAD (Metformin)			Insulin Glargine QD + OAD (Metformin)
Dosage administration		Met: 0.5 g/time, TID; Exenatide: 5 µg, BID, change to 10 µg BID after 4 weeks			Met: 0.5 g/time, TID Glargine: titrated10 µ QD
Baseline demographics		Mean	SE	SD	Mean	SE	SD
Age (years)		45.80	2.25	12.30	46.10	2.06	11.31
Total number of patients		30			30
Duration of diabetes (years)		0.61		0.11	0.56		0.12
BMI (kg/m^2)		28.60		3.50	28.10		3.39
Modifiable risk factors
HbA1c (%)		8.15		1.58	8.17		1.28
Total-cholesterol(TC) (mmol/L)		NR
HDL cholesterol (mmol/L)		NR
SBP (mmHg)		NR
Efficacy
Study duration (weeks)		52			52
HbA1c (%)	Before the treatment	8.15		1.58	8.17		1.28
	After the treatment	6.86		1.12	7.52		1.17
	Change at the end of study	−1.29	0.35	1.94	−0.65		1.73
	Weeks benefit	52			52
SBP (mmHg)	Change at the end of study	NR
HDL cholesterol (mmol/L)	Before the treatment	NR
	At the end of study	NR
	Change at the end of study	NR
Weight (BMI)	Before the treatment	28.60		3.50	28.10		3.39
	After the treatment	23.80		3.29	29.20		3.25
	Change at the end of study	−4.80	0.88	4.80	1.10	0.86	4.70
	Change to Kg (Assume mean height 1.63651)	−12.86	2.35		2.95	2.30
Hypoglycemic and adverse events
Symptomatic hypoglycemia	Number:	0.21			0.37
Severe hypoglycemia	Probability:	0.00			0.01
Gastrointestinal events	Probability:	NR			NR
Article 2
Article title		Initial observation of exenatide for treatment of type 2 diabetes
Authors		Han W.
Publication year		2013
Study drugs		Exenatide BID + OAD (Unspecified)			Insulin Glargine QD + OAD (Unspecified)
Dosage administration		Exenatide: 5 µg BID for 4 weeks, then 10 µg BID			Glargine: 10 µ/L or 0.2 µ/kg QD
Baseline demographics		Mean	SE	SD	Mean	SE	SD
Age (years)		59.80	0.81	4.60	58.00	0.60	3.50
Total number of patients		32			34
Duration of diabetes (years)		8.90		1.00	8.40		1.00
BMI (kg/m^2)		31.40		2.00	31.30		2.40
Modifiable risk factors
HbA1c (%)		8.20		0.27	8.30		0.46
Total-cholesterol (TC) (mmol/L)		NR
HDL cholesterol (mmol/L)		NR
SBP (mmHg)		NR
Efficacy
Study duration (weeks)		26			26
HbA1c (%)	Before the treatment	8.20		0.27	8.30		0.46
	After the treatment	7.09		0.09	7.19		0.07
	Change at the end of study	−1.11	0.05	0.28	−1.11		0.47
	Weeks benefit in year 1:	26			26
SBP (mmHg)	Change at the end of study	NR
HDL cholesterol (mmol/L)	Before the treatment	NR
	At the end of study	NR
	Change at the end of study	NR
Weight (BMI)	Before the treatment	87.50		1.00	88.30		1.00
	After the treatment	85.20		1.53	90.10		1.75
	Change at the end of study	−2.30	0.32	1.83	1.80	0.35	2.02
	Change to Kg (Assume mean height 1.63651)	−2.30	0.32		1.80	0.35
Hypoglycemic and adverse events
Symptomatic hypoglycemia	Number:	0.09			0.03
Severe hypoglycemia	Probability:	0.00			0.00
Gastrointestinal events	Probability:	0.56			0.09
Article 3
Article title		Clinical efficacy of exenatide treating type 2 diabetes patients who are not well controlled by oral anti-diabetic drugs
Authors		Xu H, Lu L, He Y, Chen K
Publication year		2014
Study drugs		Exenatide BID + OAD (Metformin)			Insulin Glargine QD + OAD (Metformin)
Dosage administration		OAD: MET only Exenatide: 5 µg BID			OAD: MET only Glargine: 10–18 µ QD
Baseline demographics		Mean	SE	SD	Mean	SE	SD
Age (years)		48.50		8.35	49.10		7.80
Total number of patients		20.00			22.00
Duration of diabetes (years)		2.00		1.00	2.00		1.00
BMI (kg/m^2)		27.00		1.80	26.80		2.00
Modifiable risk factors
HbA1c (%)		8.90		0.50	9.00		0.40
Total-cholesterol (TC) (mmol/L)		6.40		1.00	6.60		0.80
HDL cholesterol (mmol/L)		1.00		0.30	0.90		0.30
SBP (mmHg)		NR
Efficacy
Study duration (weeks)		12			12
HbA1c (%)	Before the treatment	8.90		0.50	9.00		0.40
	After the treatment	6.80		0.30	6.70		0.50
	Change at the end of study	−2.10	0.13	0.58	−2.30		0.64
	Weeks benefit in year 1	12			12
HDL cholesterol (mmol/L)	Before the treatment	1.00		0.30	0.90		0.30
	at the end of study	1.40		0.50	1.30		0.30
	Change at the end of study	−0.40	0.13	0.58	−0.40	0.09	0.42
Weight (BMI)	Before the treatment	27.00		1.80	26.80		2.00
	After the treatment	23.40		1.50	26.70		2.20
	Change at the end of study (or year 1):	−3.60	0.52	2.34	−0.10	0.63	2.97
	Change to Kg (Assume mean height 1.63651)	−9.64	1.40		−0.27	1.70
Hypoglycemic and adverse events
Symptomatic hypoglycemia	Number:	0.00			0.14
Severe hypoglycemia	Probability:	0.00			0.00
Gastrointestinal events	Probability:	0.40			0.00

Table A2. Meta-analysis results used for cost-effectiveness model.

Treatment	Exenatide BID + OAD			Insulin Glargine QD + OAD
	Mean	SE	SD	Mean	SE	SD
Baseline demographics
Age (years)	51.92	0.99	8.98	51.57	0.87	8.06
Total number of patients	82.00			86.00
Proportion of female (value: 0–1)	0.51			0.51
Duration of diabetes (years)	4.18	0.09	0.80	4.03	0.09	0.81
BMI (kg/m^2)	29.30	0.29	2.62	29.03	0.29	2.71
Modifiable risk factors
HbA1c (%)	8.35	0.11	1.00	8.43	0.09	0.83
Total-cholesterol (TC) (mmol/dL)	6.40		1.00	6.60		0.80
HDL cholesterol (mmol/dL)	1.00		0.30	0.90		0.30
SBP (mmHg)	131.70	0.00	0.10	131.70	0.00	0.10
Weight (kg) (converted from BMIx1.63651X1.63651)	78.48	0.77	7.00	77.75	0.78	7.24

Table A3. Final cost-effective inputs of study population.

	Mean	SE	SD
Baseline demographics
Current age (years)	51.74	0.66	8.52
Total number of patients	168.00
Proportion of female (value: 0–1)	0.51
Duration of diabetes (years)	4.10	0.06	0.80
BMI (kg/m^2)	29.16	0.21	2.66
Modifiable risk factors
HbA1c (%)	8.39	0.07	0.92
Total-cholesterol (TC) (mmol/dL)	6.50	0.14	0.90
HDL cholesterol (mmol/dL)	0.95	0.05	0.30
SBP (mmHg)	131.70	0.00	0.10
Weight (kg) (converted from BMIx1.63651X1.63651)	78.11	0.55	7.12

Table A4. Final cost-effective inputs of comparison therapies.

Treatment		Exenatide BID + OAD			Insulin Glargine QD + OAD
		Mean	SE	SD	Mean	SE	SD
Efficacy
Study duration (weeks)		30.00	11.72		30.00	9.43
HbA1c (%)	Before the treatment	8.35	0.11	1.00	8.43	0.09	0.83
	After the treatment	6.94	0.08	0.70	7.18	0.08	0.74
	Change at the end of study	−1.42	0.13	1.22	−1.25	0.12	1.11
HDL cholesterol (mmol/L)	Change at the end of study	−0.40	0.13	0.58	−0.40	0.09	0.42
Weight (kg)/BMI	Change at the end of study	−3.53	0.37	3.33	1.08	0.37	3.40
	Change to kg (Assume height 1.63651)	−7.95	0.99	8.92	1.71	0.98	9.10
Hypoglycemic events
Symptomatic	Number:	0.1116	0.0348		0.1763	0.0411
Severe adverse events	Probability:	0.0015	0.0043		0.0027	0.0055
Adverse event: Gastrointestinal events	Probability:	0.50			0.05

Note: (1) For individual study, SD calculations use the formula as a conservative estimation; (2) For individual study, SE = SD/sqrt(number of patients); (3) For synthesizing studies, mean = (mean1*N1 + Mean2*N2 + Mean3*N3)/(N1 + N2 + N3), SD = sqrt(((N1 − 1)*square(SD1) + (N2 − 1)*square(SD2) + (N3 − 1)*square(SD3))/(N1 + N2 + N3 − 3)), SE = SD/sqrt(total number of patients).

Table

Direct costs for diabetes-related events (2014 RMB): Field Survey*
Event	Fatal (¥)	Non-fatal (¥)	Maintenance (¥)‡	Reference
Ischemic heart disease	24,674.77	22,934.40	6445.00
Myocardial infarction	16,990.65	36,597.05	9887.00
Congestive heart failure	1022.31	15,978.06	8701.00
Stroke	195,444.06	20,661.38	7554.00
Blind	9602.36	14,799.72	8598.00
End stage renal disease	32,414.72	11,381.72	85,057.00
Amputation	68,379.12	74,855.80	13,440.00
Ulcer	Not Available	13,989.07	4923.50	56

*Longyou Hospital field survey, October 15, 2014; Taizhou Hospital field survey (Delphi methods included) November 27, 2014.

‡The maintenance costs for the alternative cost table comes from Gao et al.44.

Table

BMI cost curve estimation38	Cases (Male)	Cases (Female)	BMI		Expenditure(¥)/month
			Mean	SD	Mean	SD
Treatment group
Before intervention	22.00	24.00	25.20	2.60	275.10	192.50
After intervention			24.60	2.70	253.70	189.20
Difference			−0.60	0.70	−21.60	66.30
Control group
Before intervention	13.00	16.00	24.90	2.90	218.50	178.60
After intervention			25.00	2.80	299.50	198.80
Difference			0.10	0.83	81.00	190.90
Difference in difference			−0.70		−102.60
Slope (Cost/Unit BMI)					146.57
Average cost before treatment			25.05		246.80
Average cost after treatment			24.80		276.60
Duration of study	6 months

Table

BMI†	Cost/month (¥) (2007)	Cost/month (¥) (2014)	Annual cost (¥) (2014)	Annual cost (¥) (2014) halved	Annual cost (¥) (2014) 25%
20	0.00	0.00	0.00	0.00	0.00
21	0.00	0.00	0.00	0.00	0.00
22	0.00	0.00	0.00	0.00	0.00
23	0.00	0.00	0.00	0.00	0.00
24	100.20	126.63	1519.52	759.76	379.88
25	246.80	311.89	3742.69	1871.35	935.67
26	393.40	497.16	5965.87	2982.93	1491.47
27	540.00	682.42	8189.04	4094.52	2047.26
28	686.60	867.68	10,412.21	5206.11	2603.05
29	833.20	1052.95	12,635.39	6317.69	3158.85
30	979.80	1238.21	14,858.56	7429.28	3714.64
31	1126.40	1423.48	17,081.73	8540.87	4270.43
32	1273.00	1608.74	19,304.90	9652.45	4826.23
33	1419.60	1794.01	21,528.08	10,764.04	5382.02
34	1566.20	1979.27	23,751.25	11,875.62	5937.81
35	1712.80	2164.54	25,974.42	12,987.21	6493.61
36	1859.40	2349.80	28,197.59	14,098.80	7049.40
37	2006.00	2535.06	30,420.77	15,210.38	7605.19
38	2152.60	2720.33	32,643.94	16,321.97	8160.98
39	2299.20	2905.59	34,867.11	17,433.56	8716.78
40+	2445.80	3090.86	37,090.28	18,545.14	9272.57

Hui G et al.38.

†The starting point BMI = 25, cost per month = 246.8 RMB. The slope (cost per month/BMI) = 146.6 RMB. For BMI ≤ 23 the cost was set to zero.

Ji L, Hu D, Pan C, et al. Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients. Am J Med 2013;126:925. e11-. e22

 PubMed Web of Science ®Google Scholar

China GAoSo. 2010 National Physical Condition Monitoring Report. Beijing, 2010. http://www.sport.gov.cn/n16/n1077/n297454/2052709.html. Accessed on May 24, 2015

 Google Scholar

Xu H, Lu L, He Y, et al. Clinical efficacy of exenatide treating type 2 diabetes patients who are not well controlled by oral antiglycemia drugs. Chin J Prim Med Pharm 2014;1:1378-9

 Google Scholar

Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults. JAMA 2013;310:948-59

 PubMed Web of Science ®Google Scholar

Han W. Initial observation of exenatide for treatment of type 2 diabetes. J Qinghai Univ 2011;10:22-3

 Google Scholar

Currie CJ, Morgan CL, Poole CD, et al. Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes. Curr Med Res Opin 2006;22:1523-34

 PubMed Web of Science ®Google Scholar

(WHO) WHO. Noncommunicable Disease (NCD) Country Profile China 2014. Geneva, Switzerland, 2015 http://www.who.int/nmh/countries/chn_en.pdf. Accessed on May 24, 2015

 Google Scholar

Bureau of Zhejiang Province Pharmacy. Government Regulated Highest Retail Price. 2004-2013. Zhejiang Provincial Government, Zhejiang Province, 2013. http://www.zjpi.gov.cn/main/html/2013/CT10138/4c69032c8e3344f98c29388cdd8390fe.html. Accessed on September 15, 2014

 Google Scholar

Kangdele Pharmacy. Kangdele Pharmacy Retail Price. 2014. Available from: http://www.baiji.com.cn/goods-6710.html. Accessed on September 15, 2014

 Google Scholar

Yang G, Wang Y, Zeng Y, et al. Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 2013;381:1987-2015

 PubMed Web of Science ®Google Scholar

Gao L, Zhao F-L, Li S-C. Cost-utility analysis of liraglutide versus glimepiride as add-on to metformin in type 2 diabetes patients in China. Int J Technol Assess Health Care 2012;28:436-44

 PubMed Web of Science ®Google Scholar

Li H, Xu F, Wang F. Cost-effectiveness of biphasic insulin aspart 30 combined with metformin in patients with type 2 diabetes mellitus. Chin J New Drugs 2011;1:2163-70

 Google Scholar

Palmer JL, Gibbs M, Scheijbeler HW, et al. Cost-effectiveness of switching to biphasic insulin aspart in poorly-controlled type 2 diabetes patients in China. Adv Ther 2008;25:752-74

 PubMed Web of Science ®Google Scholar

Zheng Y, Wu J, Xie K. Incidence and cost of hypoglycemia episode in patients with type 2 diabetes mellitus. Hefei, China: Chinese Rural Health Service Administration, 2012. pp. 1195-8

 Google Scholar

Clarke P, Gray A, Holman R. Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Med Decis Making 2002;22:340-9

 PubMed Web of Science ®Google Scholar

Currie CJ, McEwan P, Peters JR, et al. The routine collation of health outcomes data from hospital treated subjects in the Health Outcomes Data Repository (HODaR): descriptive analysis from the first 20,000 subjects. Value Health 2005;8:581-90

 PubMed Web of Science ®Google Scholar

Matza LS, Boye KS, Yurgin N, et al. Utilities and disutilities for type 2 diabetes treatment-related attributes. Qual life Res 2007;16:1251-65

 PubMed Web of Science ®Google Scholar

Lane S, Levy A, Mukherjee J, et al. The impact on utilities of differences in body weight among Canadian patients with type 2 diabetes. Curr Med Res Opin 2014;30:1267-73

 PubMed Web of Science ®Google Scholar

Jaime Caro J, Ozer Stillman I, Danel A, et al. Cost effectiveness of rimonabant use in patients at increased cardiometabolic risk: estimates from a Markov model. J Med Econ 2007;10:239-54

 Google Scholar

Hui G, Jun L, Zhongli J. Follow-up effects of the increased physical activity on the glucolipid metabolic factors and medicla costs in type 2 diabetes patients. Chin J Rehab Med 2007;22:395-8

 Google Scholar