OBJECTIVES

Among the long-term complications arising from poor control of type 2 diabetes mellitus (T2DM), renal failure is the most expensive due to the enormous resources required for management. Evidence has shown that intensive glucose-lowering regimens may offer better protection against the development of end stage renal disease (ESRD). Gliclazide has been available as a once-daily modified release formulation (Diamicron MR) for enhancing patient’s compliance leading to better control. However, generic glicazide immediate release (IR) remains the first line therapy for new T2DM patients in Malaysia. This study compares the economic impact of Diamicron MR and generic glicazide IR in preventing diabetic ESRD in Malaysia.

METHODS

The model originally developed for Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial was used to compare the cost and cost-effectiveness of Diamicron MR and generic gliclazide IR in preventing ESRD. Efficacy, prevalence and adverse effect data were from published overseas literature. Cost data was obtained from local literature and government website. All cost data was adjusted to 2018 using the Purchasing Power Parity (PPP) index. The study was performed from the Malaysia government’s perspective.

RESULTS

Based on the ADVANCE model, the cost of prevention per episode of ESRD is substantially reduced by 61.8% for Diamicron MR as compared to generic gliclazide IR (USD150.8 vs 57.6). Deterministic sensitivity analysis was also in support of this finding.

ICER for each ESRD avoided for Diamicron MR was found to be USD6,780. We bench-marked our results to the willingness-to-pay for Malaysia which is USD6,835 from an earlier study.

CONCLUSIONS

Based on projection using the ADVANCE model, the cost of prevention per episode of ESRD appears to be less for Diamicron MR compared to generic gliclazide IR and Diamicron MR appears to be cost-effective from the Malaysia government’s perspective.