OBJECTIVES

: Achieving glycated hemoglobin (HbA_1c) <7% remains one of the main treatment objectives for type 2 diabetes (T2D). While metformin monotherapy is the preferred first-line option, patients frequently receive add-on sulfonylurea (SU) or dipeptidyl-peptidase-4 inhibitor (DPP4i). We balanced the cost-consequences of gliclazide-modified released (MR) versus sitagliptin (among the most used SU and DPP4i respectively), as add-on second-line treatment.

METHODS

: A cost-comparison model hypothetically sized at 10,000 T2D patients with HbA1c ≥7% while on metformin compared gliclazide-MR or sitagliptin as add-on second-line. HbA_1c reductions were informed by a real-world study comparing 993 patients newly treated with gliclazide-MR with 933 matched patients newly treated with sitagliptin, and whose records were extracted from the UK Clinical Practice Research Datalink (CPRD). HbA_1c-dependent risks of myocardial infraction (MI) were taken from a large prospective cohort study of the UK Biobank in which 7,316 MI events were documented from 471,399 individuals over a mean follow-up of 8.9 years. Daily drug costs were computed using defined daily doses and unit prices (€). Model parameters were varied deterministically.

RESULTS

: Within a year of treatment, 3,780 patients treated with gliclazide-MR reached the HbA_1c <7% target as compared to 2,800 patients treated with sitagliptin (+ 980 patients), avoiding 2 additional MI event (16 MI avoided with gliclazide-MR versus 14 MI avoided with sitagliptin). Gliclazide-MR acquisition cost totaled €803,000 as compared to €11,753,000 for sitagliptin acquisition (- €4,781,500). This translated into drug cost savings per additional patient reaching the HbA_1c <7% target of €10,950,000 per patient for gliclazide-MR versus sitagliptin. The results were robust to the sensitivity analysis.

CONCLUSIONS

: HbA_1c <7% target can be achieved earlier at a much lower cost with second line gliclazide-MR as compared to sitagliptin in T2D patients with HbA_1c ≥7% while on metformin treatment. Cost-saving could even be greater if the longer-term avoidance of MI is to be accounted in.