OBJECTIVES

: The ADVANCE trial demonstrated the benefit of a gliclazide MR-based intensive glucose control strategy (IGC) on the combined outcome of major macrovascular and microvascular events compared with standard glucose control strategy (SGC), primarily by enhancing renal protection. We aimed to assess the cost-effectiveness of IGC vs. SGC in Thailand based on ADVANCE results.

METHODS

: From the health-care provider perspective, we adapted a partitioned survival times model across 5 health-states (no complications, myocardial infarction, stroke, end-stage renal disease and diabetes-related eyes-disease) into the Thai context. Key clinical outcomes including macrovascular and microvascular outcomes were extracted from the ADVANCE study. Utilities outcome were extracted from literature search using the most similar contexts. Cost data, including treatment and complications, were calculated using local data source. Key outcome assessed from the model was increment cost per quality adjusted life year (QALY). We conducted scenario analyses using 9 possible scenarios and sensitivity analysis.

RESULTS

: The use of IGC strategy provided better life years gained and QALY gained (+ 0.017 and + 0.016, respectively) compared to SGC strategy. While the treatment cost was higher in the IGC arm, the cost of complications management especially for end-stage renal disease management was lower, which resulted in an incremental cost-effectiveness ratio (ICER) for QALY gained at 9,951 USD per QALY for base-case analysis. Considering the threshold recommended by WHO’s guideline (1-3X country GDP per capita), IGC strategy was cost-effective, as within 2X GDP threshold (16,340 USD/QALY). In addition, the results from 9 possible scenario analyses suggested that IGC strategy is cost effective in 7 scenarios and cost saving in 1 scenario. The sensitivity analysis confirmed the robustness of the results.

CONCLUSIONS

: In Thailand, gliclazide MR-based intensive glucose control was shown to be cost effective as compared with standard glucose control, as defined in the ADVANCE study.