Clinical and Economic Benefits of Extended-Release Metformin In Prediabetes Management
Author(s)
Nikolay Avksentyev, MA1, Yulia Makarova, PhD2, Aleksandr Makarov, BSc, MSc3.
1Financial Research Institute, Moscow, Russia; Pharmaceutical Analytics, US; Health and Market Access Consulting, Moscow, Russian Federation, 2Financial Research Institute, Moscow, Russia; Health and Market Access Consulting, Moscow, Russian Federation, 3Health and Market Access Consulting, Moscow, Russia; Pharmaceutical Analytics Middle East, Ras al Khaimah, United Arab Emirates.
1Financial Research Institute, Moscow, Russia; Pharmaceutical Analytics, US; Health and Market Access Consulting, Moscow, Russian Federation, 2Financial Research Institute, Moscow, Russia; Health and Market Access Consulting, Moscow, Russian Federation, 3Health and Market Access Consulting, Moscow, Russia; Pharmaceutical Analytics Middle East, Ras al Khaimah, United Arab Emirates.
OBJECTIVES: Prediabetes, defined by elevated blood glucose levels below diabetes thresholds, significantly increases the risk of progression to type 2 diabetes (T2D) and cardiovascular diseases (CVD). This study evaluates the clinical and economic impact of extended-release (XR) metformin treatment compared to no pharmacological intervention for patients aged 40-59 with prediabetes (fasting plasma glucose 6.1-6.9 mmol/L), focusing on healthcare resource utilization and clinical outcomes.
METHODS: The target population included Russian patients aged 40-59 years with prediabetes, who failed to achieve adequate glycemic control through lifestyle modification alone. A Markov model compared two scenarios over a 10-year horizon: XR metformin treatment in all eligible patients, versus no pharmacological intervention. Patients transitioned among four health states: prediabetes, normoglycemia, T2D, and death. Transition probabilities between health states, as well as event probabilities, were derived from literature and statistical data. Cardiovascular risk estimates were informed by hazard ratios for individuals with prediabetes. Outcomes assessed included progression rates to diabetes, incidence of cardiovascular events, overall mortality, out-of-pocket expenditures for metformin and public healthcare system costs for managing and monitoring prediabetes and its complications.
RESULTS: In a cohort of approx. 3 million individuals with prediabetes, over a 10-year period 63,524 deaths were prevented, including 41,561 from cardiovascular causes, 2,984 due to myocardial infarction and 8,884 due to stroke. Reductions in diabetes progression and cardiovascular events led to substantial decreases in healthcare resource utilization, including lower demand for antidiabetic therapies, outpatient services, cardiovascular care, and medical devices. While full XR metformin coverage adds $50.5M in annual out-of-pocket costs, healthcare savings from reduced diabetes progression, complications, and cardiovascular events total $55.2M yearly, resulting in net societal savings of $4.8M per year.
CONCLUSIONS: Routine XR metformin use in prediabetes lowers risks of T2D, CVD, and death, while reducing overall public healthcare costs despite modest individual spending.
METHODS: The target population included Russian patients aged 40-59 years with prediabetes, who failed to achieve adequate glycemic control through lifestyle modification alone. A Markov model compared two scenarios over a 10-year horizon: XR metformin treatment in all eligible patients, versus no pharmacological intervention. Patients transitioned among four health states: prediabetes, normoglycemia, T2D, and death. Transition probabilities between health states, as well as event probabilities, were derived from literature and statistical data. Cardiovascular risk estimates were informed by hazard ratios for individuals with prediabetes. Outcomes assessed included progression rates to diabetes, incidence of cardiovascular events, overall mortality, out-of-pocket expenditures for metformin and public healthcare system costs for managing and monitoring prediabetes and its complications.
RESULTS: In a cohort of approx. 3 million individuals with prediabetes, over a 10-year period 63,524 deaths were prevented, including 41,561 from cardiovascular causes, 2,984 due to myocardial infarction and 8,884 due to stroke. Reductions in diabetes progression and cardiovascular events led to substantial decreases in healthcare resource utilization, including lower demand for antidiabetic therapies, outpatient services, cardiovascular care, and medical devices. While full XR metformin coverage adds $50.5M in annual out-of-pocket costs, healthcare savings from reduced diabetes progression, complications, and cardiovascular events total $55.2M yearly, resulting in net societal savings of $4.8M per year.
CONCLUSIONS: Routine XR metformin use in prediabetes lowers risks of T2D, CVD, and death, while reducing overall public healthcare costs despite modest individual spending.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE127
Topic
Clinical Outcomes, Economic Evaluation, Health Technology Assessment
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)