EVALUASI

EKONOMI

-SYSTEMATIC
REVIEW-

NUR FATIMAH
IRENE TENRIANA KENIA
 LATAR BELAKANG

Based on the 2018 American Diabetes Association guidelines, sulfonylureas are commonly prescribed as second-line treatment with metformin when T2DM patients are not at risk for
cardiovascular diseases due to the concerns regarding long-term cardiac safety and the risk of hypoglycemia.

Dapagliflozin is the first SGLT2 inhibitor approved for glycemic control in T2DM anywhere in the world, including India. Currently, the price of dapagliflozin is more expensive than
sulfonylureas, and this can increase the cost of T2DM medications.

Therefore, economic evaluation of dapagliflozin is required to confirm whether it is cost-effective to be used as second-line therapy for T2DM patients in India. Based on our literature search, 13
economic evaluation studies were conducted in developed countries, but none were performed in low- and middle-income countries such as India16 . Therefore, our study aimed to investigate the
cost-utility of dapagliflozin compared to sulfonylureas as second-line therapy in T2DM patients based on an Indian payer’s perspective. The results of our study could be used as evidence-based
information for physicians as to whether dapagliflozin would be cost-effective to be prescribed as second-line therapy compared to sulfonylureas for T2DM patients in India.

Compared with sulfonylureas, themost commonly used oral antidiabetics beside metformin,dapagliflozin showed similar HbA1c reduction, but was asso-ciated with significant weight loss and
significantly fewerhypoglycemic events. Dapagliflozin is thus an alternative tosulfonylureas for T2DM patients inadequately controlled onmetformin plus diet/exercise

Bhavani Shankara Bagepally, dkk 2021 - Cost-Utility Analysis of Dapagliflozin Compared to Sulfonylureas for Type 2 Diabetes as SecondLine Treatment in Indian Healthcare Payer’s
Perspective

RUMUSAN MASALAH
Diabetes mellitus (DM) is included in the ten non-communicable diseases that occupy the top rank of most cases and is the disease with the largest financing burden. Diabetes mellitus type 2
(DMT2) is known as one of the health problems that puts a large economic burden on health care systems around the world. Variations in the use of drug therapy will result in differences in
the effectiveness and cost of therapy, so it is necessary to conduct a cost-effectiveness analysis.
 TOPIC & STRATEGY
Topic :

“Analysis Cost Effectiveness of treatment to Diabetic type 2 for Metformin”

P (Patient/Population) Adult with diabetic type 2, start age 20

– 79, Gender Female
I ( Intervention) Metformin 500 mg and Dapagliflozin

C (Comparative) Sulfonylurea

O (Outcomes) ICER per QALY

Search Literature : Electronic Source – Data base, Electronic Libraries, and Internet
 KRITERIA KELAYAKAN

Inclution Exclution
Source Pubmed
Dates December 2016 – December 2021
Language English
Population Adult with diabetes type 2 Children
Intervention Metformin and Dapagliflozin Study only using metformin or
dapagliflozin for diabetic type 2 therapy
Comparative Sulfonylurea Other comparator
Outcome ICER and QALY Other outcome
Studies All studies
 Population Intervention Comparative Outcomes

MeSH Term Diabetes type 2 Metformin and Dapagliflozin Sulfonylurea Cost Effectiveness Analysis

Synonim • Diabetes Mellitus, Noninsulin- • Analyses, Cost-Benefit

Dependent • Analysis, Cost-Benefit
• Diabetes Mellitus, Ketosis- • Cost-Benefit Analyses
Resistant • Cost Benefit Analysis
• Ketosis-Resistant Diabetes • Analyses, Cost Benefit
Mellitus • Analysis, Cost Benefit
• Diabetes Mellitus, Non Insulin • Cost Benefit Analyses
Dependent • Cost Effectiveness
• Non-Insulin-Dependent Diabetes • Effectiveness, Cost
Mellitus • Cost-Benefit Data
• Diabetes Mellitus, Stable • Cost Benefit Data
• Stable Diabetes Mellitus • Data, Cost-Benefit
• Diabetes Mellitus, Type II • Cost-Utility Analysis
• NIDDM • Analyses, Cost-Utility
• Diabetes Mellitus, Noninsulin • Analysis, Cost-Utility
Dependent • Cost Utility Analysis
• Diabetes Mellitus, Maturity-Onset • Cost-Utility Analyses
IDENTIFIKASI • Maturity-Onset Diabetes Mellitus
MODY
• Economic Evaluation
Economic Evaluations
• •
• Diabetes Mellitus, Slow-Onset • Evaluation, Economic
KATA KUNCI • Slow-Onset Diabetes Mellitus • Evaluations, Economic
• Type 2 Diabetes Mellitus • Marginal Analysis
• Noninsulin-Dependent Diabetes • Analyses, Marginal
Mellitus • Analysis, Marginal
• Maturity-Onset Diabetes • Marginal Analyses
• Diabetes, Maturity-Onset • Cost Benefit
• Maturity Onset Diabetes • Costs and Benefits
• Type 2 Diabetes • Benefits and Costs
• Diabetes, Type 2 • Cost-Effectiveness Analysis
• Diabetes Mellitus, Adult-Onset • Analysis, Cost-Effectiveness
• Adult-Onset Diabetes Mellitus • Cost Effectiveness Analysis
• Diabetes Mellitus, Adult Onset
HASIL PENCARIAN MESH
 SEARCH LITERATURE/STRATEGY

Dapagliflozin AND Sulfonylurea

and Metformin
REVIEW RESULT
 CRITICAL
APPRAISAL

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CONCLUSIONS FROM ANALYZING

From several studies that analyzed to the Cost Analysis Effectiveness of Metformin and Dapagliflozin treatment, it was
shown that it was a more cost-effective alternative treatment for patients with T2DM whose metformin regimen did not have
sufficient glycemic control, could provide good results non-clinical weight loss but with a note that the consumption of
medication according to the regimen, as well as able to provide an increase in the patient's quality of life.