The cost-effectiveness of metformin in pre-diabetics: a systematic literature review of health economic evaluations

ABSTRACT

Objectives: Our aim was to systematically identify and appraise cost-effectiveness studies of metformin in prediabetic subjects.

Methods: A systematic literature review was conducted and reported according to standard guidlines. The search was conducted in PubMed, Embase, International Society for Pharmacoeconomics and Outcomes Research (ISPOR) presentation database and the Cost-Effectiveness Analysis (CEA) and Center for Reviews and Dissemination (CRD) registries. All cost-effectiveness studies assessing metformin in prediabetic patients were included.

Results: Twenty-three reports were included. Metformin and intensive lifestyle changes (ILC) interventions were always cost-effective compared to placebo. ILC was cost-effective and sometimes dominant compared to metformin. Metformin was cost-saving compared to ILC in the short and medium-term. Although, in the long term, metformin was more expensive than ILC in terms of direct medical costs, when indirect non-medical costs are included, metformin less expensive than ILC. One study reported that for patients with Body Mass Index (BMI) higher than 30 kg/m2, metformin is a cost-effective strategy compared to placebo and ILC. However, this finding was not confirmed by other retrieved studies.

Conclusion: ILC is cost-effective compared to metformin and, both of them are cost-effective compared to placebo. Metformin may be cost-saving in the short- to medium-term and possibly in the long-term.

KEYWORDS:

• Cost-effectiveness
• diabetes prevention
• prediabetes
• metformin
• lifestyle changes
• systematic review

Article Highlights

• Cost-effectiveness studies in high-risk prediabetic subjects substantiate the clinical evidence supporting the use of intensive lifestyle intervention and metformin for the prevention of Type 2 diabetes mellitus (T2DM).

• A systematic literature review was conducted to evaluate all cost-effectiveness studies assessing metformin, the only available pharmacological treatment, in prediabetic patients.

• The result shows that ILC is cost-effective compared to metformin and, both of them are cost-effective compared to placebo.

• One study reported that for patients with Body Mass Index (BMI) higher than 30 kg/m2, metformin is a cost-effective strategy compared to placebo and ILC. However, this finding was not confirmed by other retrieved studies.

• Metformin also appears more cost-effective compared to intensive lifestyle interventions in a patient with high BMI. The evidence in favor of metformin in relevant subgroups should be explored in future economic evaluations.

• In the context of the increasing prevalence of diabetes, ILC and metformin are effective and cost-effective options to prevent and subsequently reduce the incidence of T2DM

Author contributions

Samron Brhane Gebregergish and Mahmoud Hashim had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors agree to be accountable for all aspects of the work.

• Study concept and design: Samron Brhane Gebregergish, Mahmoud Hashim, Marco Rauland, Ulrike Gottwald-Hostalek

• Acquisition of data: Samron Brhane Gebregergish

• Analysis and interpretation of data: Samron Brhane Gebregergish, Mahmoud Hashim

• Drafting of the manuscript: Samron Brhane Gebregergish, Mahmoud Hashim

• Critical revision and approval of the manuscript for important intellectual content: Samron Brhane Gebregergish, Mahmoud Hashim, Bart Heeg, Thomas Wilke, Marco Rauland, Ulrike Gottwald-Hostalek

• Obtaining funding: Samron Brhane Gebregergish, Bart Heeg, Marco Rauland, Ulrike Gottwald-Hostalek

• Administrative, technical, or material support: Mahmoud Hashim

• Supervision: Bart Heeg, Thomas Wilke, Marco Rauland, Ulrike Gottwald-Hostalek

Declaration of interest

SB Gebregergish is an employee of Ingress-health. Ingress-health receives funding from various pharmaceutical companies including but not limited to Merck, UCB, JNJ and AstraZeneca. M Hashim is an employee of ingress-health. Ingress-health receives funding from various pharmaceutical companies including but not limited to Merck, UCB, JNJ and AstraZeneca. B Heeg is a partner of ingress-health. Ingress-health receives funding from various pharmaceutical companies including but not limited to Merck, UCB, JNJ and AstraZeneca. T Wilke has received honoraria from several pharmaceutical/consultancy companies e.g. Novo Nordisk, Abbvie; Merck; GSK, BMS, LEO Pharma, Astra Zeneca, Bayer, Boehringer. M Rauland and U Hostalek are employees of Merck KgA. 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.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was funded by Merck KGaA.