OBJECTIVES

Acute pancreatitis has significant morbidity and mortality. Previous studies have raised the possibility that therapies such as dipeptidyl peptidase 4 inhibitors (DPP4i) may increase the risk of acute pancreatitis. The aim of this study was to assess the impact of adding acute pancreatitis as a complication on incremental cost-effectiveness ratio (ICER), using the IQVIA Core Diabetes Model v9.5.

METHODS

Baseline characteristics and treatment effects from the observational EDGE study comparing metformin+vildagliptin (M+V) with metformin+sulphonylurea (M+S) were employed: mean age 57.8 years, diabetes duration 6 years, 54.8% male, HbA1c 8.2% and BMI 29kg/m²; HbA1c reductions were -0.99% and -1.19%, with changes of -0.3kg and -1.6kg in body weight for M+S and M+V, respectively. Acute pancreatitis (AP) occured in 0.65% and 0.44% of patients in the M+V and M+S arms, respectively. Case fatality was 8.7%. Direct costs and disutility score of an AP event were GBP 23,865 and -0.25, respectively. Cardiovascular disease and mortality risks were determined using the UKPDS82 outcomes model. The time horizon was 10 years.

RESULTS

Not including pancreatitis as a complication resulted in total costs of GBP 13,592/11,314 and total quality-adjusted life years (QALYs) of 5.042/4.991 for M+V/M+S arms, respectively. The resulting ICER was 45,572 GBP/QALY. Including pancreatitis as a complication resulted in total costs of GBP 14,599/12,028 and total QALYs of 5.027/4.983 for M+V/M+S arms. The resulting ICER was 58,298 GBP/QALY. Cumulative incidence of AP over a 10-year time horizon was 5.69% for M+V and 3.89% for M+S. The mean AP treatment cost per patient for M+V/M+S was GBP 1,069/723.

CONCLUSIONS

Adding acute pancreatitis as a complication to a diabetes model can have a considerable impact on the outcomes of cost-effectiveness analyses due to the associated mortality and high cost of the complication.