THE COST-EFFECTIVENESS OF CANAGLIFLOZIN VERSUS INSULIN-SECRETAGOGUES (SULPHONYLUREAS) OR INSULIN IN PATIENTS WITH TYPE 2 DIABETES MELLITUS (T2DM) AS AN ADD-ON TO METFORMIN 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 Sulphonylureas (SU) and insulin are used routinely in the management of T2DM but are associated with weight gain and increased risk of hypoglycaemia. Canagliflozin is a new insulin-independent oral glucose lowering agent with added benefits of weight loss, blood pressure reduction and no increased risk of hypoglycaemia. This analysis estimated the cost-effectiveness of canagliflozin compared to either SU or insulin in patients failing to achieve glycaemic control on metformin monotherapy in Ireland. METHODS The Economic and Health Outcomes Model of T2DM (ECHO-T2DM) was used to simulate the lifetime outcomes and costs associated with canagliflozin (100mg, titrated to 300mg as needed to maintain glycaemic control) versus SU and versus insulin glargine. Patient characteristics and treatment effects for the SU comparison were sourced from a head-to-head randomized clinical trial vs. glimepiride. Hypoglycaemia rates were halved to reflect gliclazide MR (the preferred SU in Ireland). Patient characteristics for the insulin glargine comparison were obtained from the pooled canagliflozin add-on to metformin RCTs; treatment effects were sourced from a network meta-analysis. Costs were localised and inflated to 2013 euros. Utilities were sourced from the literature. Costs and outcomes were discounted at 5% annually. RESULTS The incremental costs, QALY gains and ICERs associated with canagliflozin were €2,404, 0.215 QALYs and €11,191 per QALY gained, respectively, versus SU and €2,352, 0.228 QALYs and €10,305 per QALY gained, respectively, versus insulin glargine. Key drivers were decreased hypoglycaemia and lower weight-related disutility versus both comparators, as well as better HbA durability versus SU. In both cases, using an acceptable Irish willingness-to-pay threshold, the probability of being cost-effective was in excess of 97%. Sensitivity analyses support the robustness of these results. CONCLUSIONS These simulations suggest that canagliflozin is a cost-effective treatment choice versus both gliclazide MR and insulin glargine in patients failing to control glycaemia on metformin alone.
Conference/Value in Health Info
2014-11, ISPOR Europe 2014, Amsterdam, The Netherlands
Value in Health, Vol. 17, No. 7 (November 2014)
Code
PDB81
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Diabetes/Endocrine/Metabolic Disorders