IS CANAGLIFLOZIN COST-EFFECTIVE COMPARED TO SITAGLIPTIN ACROSS MULTIPLE LINES OF TYPE 2 DIABETES MELLITUS (T2DM) THERAPY IN IRELAND?
Author(s)
Bacon T1, Willis M2, Johansen P2, Neslusan C3, Nuhoho S4, Worbes-Cerezo M5
1Janssen-Cilag Ltd, Dublin, Ireland, 2The Swedish Institute for Health Economics, Lund, Sweden, 3Janssen Global Services, LLC, Raritan, NJ, USA, 4Janssen-Cilag A/S, Birkerød, Denmark, 5Janssen-Cilag UK, High Wycombe, UK
OBJECTIVES Canagliflozin is a new oral agent for the treatment of T2DM that inhibits sodium-glucose co-transporter 2 (SGLT2), thereby leading to inhibition of glucose reabsorption and urinary glucose excretion which results in reductions in blood glucose, weight, and blood pressure. The purpose of this analysis was to evaluate the cost-effectiveness of canagliflozin vs. sitagliptin – a recommended and widely used dipeptidyl peptidase-4 inhibitor (DPP4) – in dual (with metformin), triple (with metformin + sulphonylurea) and add-on to basal insulin (with or without other anti-hyperglycaemic agents) therapy lines in Ireland. METHODS The Economic and Health Outcomes Model of T2DM (ECHO-T2DM) [using updated UKPDS 82 mortality and risk equations] was used to simulate lifetime outcomes and costs of patients on either canagliflozin (100mg, titrated to 300mg as needed to maintain glycaemic control) or sitagliptin 100mg. Patient characteristics and treatment effects were sourced from head to head randomized clinical trials for dual and triple therapy. For the add-on to insulin therapy simulations, treatment effects were sourced from a network meta-analysis. Costs were localised and inflated to 2013 euros. Utilities were sourced from the literature. Both costs and outcomes were discounted at 5%. RESULTS Incremental costs, QALYs and ICERs for canagliflozin vs. sitagliptin were €1,360, 0.059 QALYs and €23,118 per QALY, respectively, in dual therapy; €108, 0.093 QALYs and €1,172 per QALY, respectively, in triple therapy; and €550, 0.068 QALYs and €8,047 per QALY, respectively, in add-on to insulin. In all three scenarios, canagliflozin was cost-effective using the acceptable willingness-to-pay threshold in Ireland. Sensitivity analyses suggest that these results are robust. CONCLUSIONS These simulations suggest that the use of canagliflozin in patients in need of additional glycaemic control in dual, triple and add-on to insulin lines of therapy is a more efficient use of health care funds than the use of sitagliptin in the Irish setting.
Conference/Value in Health Info
2014-11, ISPOR Europe 2014, Amsterdam, The Netherlands
Value in Health, Vol. 17, No. 7 (November 2014)
Code
PDB76
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Diabetes/Endocrine/Metabolic Disorders