OBJECTIVES

: To compare the efficacy, safety and long-term cost-effectiveness of lixisenatide 20 ug once daily (Lixisenatide) versus basal insulin (BI) and premixed insulin (Premix) once daily for patients with type 2 diabetes mellitus (T2DM) inadequately controlled by oral antidiabetic drugs (OADs) in China.

METHODS

: A systematic literature review was conducted in PubMed, Cochrane Library, CNKI, and WanFang database up to July 2018. The network meta-analysis (NMA) was applied to calculate the relative risk (RR) or mean difference (MD) with 95% credibility interval (95%Crl) within a Bayesian framework. The IQVIA CORE Diabetes model was used to estimate the quality-adjusted life-years (QALYs), direct medical costs and incremental cost-effectiveness ratios (ICERs) from the perspective of China healthcare system.

RESULTS

: Eleven randomized controlled trials involving 4,511 patients were included in the NMA. There is no significant difference in the HbA1c reduction comparing Lixisenatide with BI (MD=0.27%, 95%Crl: -0.02%, 0.57%) and Premix (MD=0.32%, 95%Crl: -0.01%, 0.66%). Lixisenatide was associated with a statistically significant reduction in the body weight versus BI (MD=-3.22kg, 95% CrI: -5.51kg to -0.94kg) and Premix (MD=-2.68kg, 95%CrI: -5.16kg to -0.20kg). The incidence of symptomatic hypoglycemia was significantly lower for Lixisenatide compared with BI (RR=0.22, 95% CrI: 0.09 to 0.52) and Premix (RR=0.17, 95% CrI: 0.07 to 0.41). The cost-effectiveness analysis indicated that assuming the willingness-to-pay threshold was set at 3 times GDP per capita per QALY in China (RMB 178,980), Lixisenatide was a cost-effective option with ICERs of RMB 72,492/QALY and RMB 140,830/QALY gained versus BI and Premix, respectively.

CONCLUSIONS : For T2DM patients inadequately controlled by OADs, Lixisenatideis is associated with significantly decreased body weight and lower risk of symptomatic hypoglycemia compared with BI and Premix, accompanied by a similar HbA1c reduction. It is a cost-effective treatment alternative in China.