OBJECTIVES: Access to medicines in Chile for the treatment of T2DM is restricted by ministerial programs. However, it must address cost-effectiveness analysis and prioritization mechanisms in allocating scarce resources. The study aims to evaluate the cost-effectiveness of drug therapies funded by the Chilean Diabetes Mellitus type 2 program in patients who do not respond to the treatment with metformin and glibenclamide

METHODS: A discrete event simulation model was performed to predict the micro and macrovascular complications using the UKPDS risk equations. A cohort of 100,000 patients was simulated using the risk profile of patients who do not respond to the current funded pharmacological treatment obtained from the National Health Survey (2018). The combination of glibenclamide/metformin was compared against 15 pharmacological treatments approved in Chile, such as GLP-2 agonists, and DPP4 inhibitors, among others. Costs were obtained from building de-novo resource utilization baskets and evaluated using the Cost Verification Survey of the Ministry of Health. Utilities and disutilities were extracted from a systematic review previously performed. A discount rate of 3% was employed for both costs and benefits. A lifetime horizon was used in this study. Additionally, deterministic sensitivity analysis and a probabilistic sensitivity analysis were performed.

RESULTS: The combination of empagliflozin/linagliptin had the highest QALYs (12.304 QALYs), while Liraglutide was the most expensive alternative with an accumulating cost of US$31,963. Glibenclamide/metformin was the most cost-effective alternative, followed by empagliflozin/linagliptin with an ICER of $751,605 per additional QALY. Vildagliptin, Canagliflozin, and Dulaglutide were extended-dominated alternatives, while the rest of the strategies were dominated.

CONCLUSIONS: Glibenclamide/metformin was the most cost-effective alternative using a threshold of US$12,5000 per QALY, followed by Empagliflozin/Linagliptin, which was US$132,967 more expensive than glibenclamide, but also 0,177 QALYs more effective than glibenclamide.