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COST EFFECTIVENESS OF DAPAGLIFLOZIN/METFORMIN VERSUS

GLIBENCLAMIDE/METFORMIN FOR THE TREATMENT OF TYPE 2 DIABETES IN
CHILE

Article  in  Value in Health · May 2016

DOI: 10.1016/j.jval.2016.03.1305

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A204 VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
investigational treatment technologies, the cost-effectiveness analysis (CEA) was
performed, and demonstrated the economic benefits of IGlar. IGlar had significantly
lower cost-effectiveness compared to IDet, which is also confirmed by bilateral
analysis of sensitivity. Total lifetime direct costs were 1996,7 euro lower with insu-
lin glargine than with insulin detemir.  Conclusions: This study to address the
health economic implications of treating T2DM patients failing oral anti-diabetics
with a IGlar versus IDet. Our projections indicate that improved HbA1c levels with
IGlar treatment are associated with improvements in life expectancy, and that IGlar
represents excellent value for money compared to IDet in the Kazakhstan.
PDB42
COST EFFECTIVENESS OF ALLOGENIC PANCREATIC ISLET TRANSPLANTATION
VERSUS WHOLE PANCREAS TRANSPLANTATION IN THE UNITED KINGDOM
De Francesco M 1, Johnson P 2, Lamotte M 1
. . . recently FDA-approved drugs for treating radioiodine (RAI)-refractory differenti-
1IMS Health, Vilvoorde, Belgium, 2John Radcliffe Hospital, Oxford, Belgium
Objectives: The study objective was to evaluate the cost-effectiveness of allogenic
pancreatic islet transplantation (PIT) compared to whole pancreas transplantation
(WPT) in adult patients with brittle type 1 diabetes (T1DM) and eligible for β -cell
replacement in UK.  Methods: A life-time horizon Markov model was developed
to reflect the progression of patients who undergo β -cell replacement. The cohort
moves across 8 health states: transplant, insulin independent, insulin depend-
ent without and with complete graft function loss, macrovascular complications,
microvascular complications, macro- and microvascular complications, death. Acute
adverse events were also considered. Parametric extrapolations of insulin independ-
ence and graft survival were performed based on data from the Collaborative Islet
Transplantation Registry (CITR) and the International Pancreas Transplant Registry
(IPTR). All other clinical and quality of life data were derived from literature. Costs
from the 3rd party payer perspective were obtained from official sources and from
the literature. Both costs and health outcomes, life years (LYs) and quality adjusted
LYs (QALYs), were annually discounted at 3.5%.  Results: As expected, better overall
survival and lower complication rates increased both LYs and QALYs gained in PIT
vs WPT, resulting in incremental values of 1.15 and 0.62 respectively. PIT was also
associated with an incremental cost of £18,132 vs WPT. The resulting cost per LY and
QALY gained with PIT vs WPT were £15,784 and £29,281 respectively. Deterministic
and probabilistic sensitivity analysis showed overall robustness of the basecase
results, with 74% of simulations located below the threshold of £100,000/QALY,
usually considered for the assessment of orphan drugs in UK.  Conclusions: To
our knowledge, this is the first model to assess PIT against WPT for the treatment of
brittle T1DM. Recognizing limitations, mainly due to the lack of direct comparative
evidence, PIT seems to represent a cost-effective option to WPT in UK.
PDB43
COST EFFECTIVENESS OF DAPAGLIFLOZIN/METFORMIN VERSUS
GLIBENCLAMIDE/METFORMIN FOR THE TREATMENT OF TYPE 2 DIABETES IN
CHILE
Rojas R , Vargas C , Balmaceda C , Espinoza M A
. . . . . Objectives: Neuropathic pain is a complication of diabetes mellitus that requires
Pontificia Universidad Catolica de Chile, Santiago, Chile
Objectives: To assess the cost-effectiveness of dapagliflozin in combination with
metformin versus glibenclamide in combination with metformin for the treatment
of patients with type 2 diabetes, from the perspective of the Chilean public health-
care system  Methods: A discrete event simulation model was built to estimate the
lifetime expected costs and health benefits measured as quality adjusted life years
(QALYs). Individual patient risk profile based on the Chile 2010 national health survey
were used. Time to event for disease complications and death was estimated using the
published equations from the UKPDS Outcomes Model 2 study. Efficacy was obtained
from a network meta-analyses and costs were estimated from local sources. Utilities
were obtained from the literature. A time horizon of 50 years and a 3% discount rate
was considered for costs and outcomes. Probabilistic sensitivity analyses was per-
formed  Results: The ICER of dapagliflozin/metformin compared to glibenclamide/
metformin was US$ 20.811/QALY at a price of US$38 per month (pm); US$13.887/QALY
at a price of US$29 pm and US$6.963/QALY at a price of US$19 pm. The probability of
cost effectiveness of dapagliflozin/metformin at a pm price of US$38 was 42% and
increases to 95% when the pm price is reduced to US$19  Conclusions: dapagli-
flozin/metformin can be considered cost-effective at a particular price range. These
results provide decision makers useful information about the value of incorporating
these drugs into the public Chilean healthcare system
PDB44
COST-EFFECTIVENESS ANALYSIS OF DIABETIC NEPHROPATHY MANAGEMENT
Alenzi E O 1, Kamal K 2
. . . DIABETES/ENDOCRINE DISORDERS – Patient-Reported Outcomes & Patient
1West Virginia University, School of Pharmacy, Morgantown, WV, USA, 2Duquesne University
Mylan School of Pharmacy, Pittsburgh, PA, USA
Objectives: To evaluate the cost-effectiveness of diabetic nephropathy man-
agement using Angiotensin-converting-enzyme inhibitors (ACEIs), Angiotensin
II receptor blockers (ARBs), or a combination therapy of both among adults with
diabetes mellitus and microalbuminuria from a U.S. health care payer perspec-
tive.  Methods: Markov model was developed to simulate the progression of
diabetic nephropathy in a hypothetical cohort of 10,000 individuals with diabe-
tes and microalbuminuria. Three strategies were compared: using ACEIs, ARBs, or
a combination of them. Lives saved without developing end stage renal disease
(ESRD), costs, average cost-effectiveness ratios (ACER), and the incremental cost-
effectiveness ratios (ICERs) were the outcome measures assessed over a 20-year
horizon. Data from randomized clinical trials, epidemiological studies, and costs,
were complemented to build the model.  Results: Treating microalbuminuria with
a combination of ACEIs and ARBs was associated with highest cost ($ 337,410,000)
and least effect (6,157 lives saved without ESRD). Management of microalbuminuria
with ACEIs was less costly with lowest ACER ($US19,340.36 per treatmnet success
without ESRD). Treating microalbuminuria with ARBs was the cost-effective strategy
to manage the early stages of diabetic nephropathy with an ICER determined to
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be $US 172,439.3 per additional 20-year treatment success using ARBs relative to
ACEIs.  Conclusions: Management of the diabetic nephropathy from the earliest
stage (microalbuminuria) using ARBs is the cost-effective strategy to reduce death
and end-stage kidney disease for individuals with diabetes and microalbuminuria
if they do not have contraindications.
PDB45
COST EFFECTIVENESS OF LENVATINIB, SORAFENIB, AND PLACEBO IN
TREATMENT OF RADIOIODINE-REFRACTORY DIFFERENTIATED THYROID
CANCER
Huang W 1, Chen L 1, Cao V 1, Sung H 1, Yokokura M 1, Ting J 1, Wilson L 2
. . . . . . .
1UCSF, San Francisco, CA, USA, 2University of California, San Francisco, San Francisco, CA, USA
Objectives: Lenvatinib (Lenvima®) and sorafenib (Nexavar®) are the two most
ated thyroid cancer (DTC). Both demonstrated superior progression-free survival
over placebo in their respective phase III clinical trials. In this study, we compared
the cost-effectiveness of the two treatments and placebo in treating RAI-refractory
DTC in the U.S. from a societal perspective.  Methods: A Markov model was devel-
oped to estimate the costs and health benefits for treatment of RAI-refractory DTC.
Transition probabilities were from two phase-III trials—the SELECT trial comparing
lenvatinib to placebo, and the DECISION trial comparing sorafenib to placebo. We
used a bi-monthly cycle length for a lifetime time horizon. We adjusted the survival
rates based on comparisons of the two placebo groups in two trials. Direct medical
costs and utility data were obtained from Redbook, Healthcare Cost and Utilization
Project, Medicare Fee Schedule, and published literature. All costs were adjusted to
2015 USD, discounted at 3% annually. One-way probabilistic sensitivity analyses
were performed.  Results: In the base case, placebo was most costly ($851,256),
followed by lenvatinib ($197,374), and sorafenib ($164,371). Placebo was dominated,
being the most costly and least effective treatment. High costs of placebo were
driven by costs associated with palliative care. At a willingness-to-pay threshold
of $100,000/QALY, lenvatinib was the most cost-effective option at $79,118/QALY
gained compared with sorafenib. The treatment decisions were found to be sensi-
tive to the treatment costs of lenvatinib and sorafenib, and the health utility of
continuing with lenvatinib.  CONCLUSIONS: Given a willingness-to-pay threshold
of $100,000/QALY, lenvatinib is the most cost-effective treatment, compared with
sorafenib and placebo. This finding supports the National Comprehensive Cancer
Network guidelines recommending tyrosine-kinase inhibitors for RAI-refractory
DTC. Future research efforts should focus on updating results with real-world data
and directly comparing the two treatments.
PDB46
UTILIZATION PATTERN OF PRESCRIPTION PAIN MEDICATION AMONG ADULTS
WITH DIABETES MELLITUS
Zhong L 1, Douglas C 2, Hutchison R 1, Potter D 2
. . . .
1Texas A&M University, College Station, TX, USA, 2Texas A&M University, Kingsville, TX, USA
palliation frequently. This study aims to comprehensively evaluate the use of pre-
scription pain medications in diabetic patients using nationally representative
data from the Medical Expenditure Panel Survey.  Methods: Non-institutionalized
patients, age ≥ 18, with diabetes (Clinical Classification Code 049 or 050) were identi-
fied from latest available 2013 MEPS datasets and compared to individuals with-
out diabetes during the interview year. The cohorts were examined for the use
of prescription pain medications, including: opioids, COX2-inhibitors, antidepres-
sants, anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDS) and other
adjuvant analgesics. The cohorts were compared using multivariate regression for
complex survey based on the specific pain medication refill numbers, days of supply
and expenses.  Results: A total of 36,940 respondents were sampled in 2013, includ-
ing 2,849 patients with diabetes mellitus with or without complications. Diabetes
prevalence was 24,710,612 (95% CI: 23,406,617, 26,014,607). Annual days of supply
for prescription pain meds were 47 days longer for the adult diabetic population
(n= 2781) vs. the non-diabetic adult population (n= 23535) (95% CI: 31.7, 62.4 days).
Diabetic patients had a 45% (95% CI: 31%, 61%) increase in the odds of using opioid
analgesics compared to non-diabetic individuals and 82% increase in the odds of
overall prescription pain medications use vs non-diabetic individuals (95% CI: 67%,
99%).  Conclusions: Diabetes mellitus was associated with higher probabilities
and amount of pain medication consumption. This study provides a national esti-
mate of utilization patterns of pain medications in adult diabetic patients.
Preference Studies
PDB47
ADHERENCE TO ORAL ANTIDIABETIC MEDICATION IN TYPE 2 DIABETES
MELLITUS CLIENTS IN THE VOLTA REGION OF GHANA
Sefah I A 1, Okotah A 2
. . .
1GHANA HEALTH SERVICE, KETA, Ghana, 2JOHN SNOW INC, ACCRA, Ghana
Objectives: This study sought to assess adherence to oral anti-diabetes melli-
tus medications and associated factors among clients reporting to four randomly
selected Hospitals in the Volta region of Ghana.  Methods: A cross-sectional study
was conducted among type 2 diabetes mellitus clients who attended the Diabetes
Clinic of four randomly selected Hospitals in the Volta region of Ghana between
the months of January 2015 to March 2015. Adherence prevalence was assessed
using the eight (8)-item Morisky Medication Adherence scale. Study participants
were interviewed using a structure questionnaire to, among other things, deter-
mine the commonest self-reported reason (s) of non adherence. Data generated
were analyzed using SPSS version 21. Cross-tabulation analysis was performed
between the adherence levels and the indicators generated from the question-
naire. Multiple logistic regression was further performed between adherence level