COST-EFFECTIVENESS OF GLICLAZIDE MR-BASED INTENSIVE GLUCOSE CONTROL VERSUS STANDARD GLUCOSE CONTROL IN TYPE 2 DIABETES MELLITUS. AN ECONOMIC ANALYSIS IN VIETNAM OF THE ADVANCE TRIAL.
Author(s)
Ethgen O1, Nguyen NTQ2
1University of Liege, Liege, Belgium, 2Queen's University Belfast, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
OBJECTIVES ADVANCE was a large multinational trial conducted over 5 years in type 2 diabetes. 5,571 patients randomly assigned to gliclazide MR-based intensive glucose control (IGC) were compared to 5,569 patients receiving standard glucose control (SGC). IGC was shown to decrease the combined outcome of major macrovascular and microvascular events, primarily by enhancing renal protection. We assessed the cost-effectiveness of IGC vs. SGC based on ADVANCE results and using a Vietnamese health care payer perspective. METHODS A partitioned survival times model across 5 health-states was designed (no complications, myocardial infraction, stroke, end-stage renal disease (ESRD) and diabetes-related eyes-disease). Time-to-event curves were informed by the cumulative incidence of events and corresponding hazard ratios from ADVANCE. Health outcomes were expressed in terms of ESRD avoided and QALYs. Costs comprised treatment and health state costs. Utilities and costs were documented from literature reporting Vietnamese estimates. For sensitivity analyses, all parameters were individually varied within their 95%CI bounds when available or within a ±30% range, alternatively. RESULTS Over 5-year, IGC avoided 6.5 additional ESRD events per 1,000 patients treated (SGC: 10.0 events vs. IGC: 3.5 events) and provided 0.0016 additional QALYs (SGC: 3.555 QALYs vs. IGC: 3.570 QALYs). Total costs were nearly similar between the 2 strategies (SGC: $3,757 vs. IGC: $3,786). Although the treatment cost was higher for IGC (SGC: $873 vs. IGC $1,703), it was mainly offset by the savings from better renal protection with IGC (SGC: $1,508 vs. IGC: $577). The incremental cost-effectiveness ratio of IGC vs. SGC was $1,878/QALY gained, far below the threshold recommended by the WHO (i.e. 3×GDP per inhabitant ≈ $7,500 in Vietnam). The findings were robust to sensitivity analysis. CONCLUSIONS In Vietnam, gliclazide MR-based intensive glucose control was shown to be very cost-effective as compared to standard glucose control, as defined in the ADVANCE study.
Conference/Value in Health Info
2019-11, ISPOR Europe 2019, Copenhagen, Denmark
Code
PDB35
Topic
Economic Evaluation
Disease
Diabetes/Endocrine/Metabolic Disorders