OBJECTIVES: Key challenges in the adequate management of type 2 diabetes include maintaining glycemic control whilst minimizing the risk of hypoglycemia, without increasing body weight.  Glucagon-like peptide-1 (GLP-1) receptor agonists provide a multi-factorial approach to treatment, compared with traditional glucocentric approaches.  The present analysis aimed to compare the cost-effectiveness of GLP-1 receptor agonists for the treatment of diabetes in the UK.

METHODS: Changes in glycated hemoglobin, blood pressure and body mass index upon initiation of liraglutide 1.2mg, exenatide BID and lixisenatide were taken from a network meta-analysis of 13 randomized controlled trials evaluating the efficacy and safety of GLP-1 receptor agonists for the treatment of patients with type 2 diabetes uncontrolled on oral antidiabetic drugs.  Patient lifetime projections of clinical outcomes and direct costs (taken from published UK-specific sources, 2013 GBP) were made in a cohort based on the LEAD-6 trial using a published and validated diabetes model.  Outcomes were discounted at 3.5% annually.  Sensitivity analyses were performed.

RESULTS: Liraglutide was associated with improved quality-adjusted life expectancy versus exenatide (9.17 versus 9.16 quality-adjusted life years [QALYs]) and lixisenatide (9.17 versus 9.12 QALYs).  Improvements were driven by improved glycemic control, leading to a reduced incidence of diabetes-related complications.  Liraglutide was associated with reduced costs versus exenatide (GBP37,520 versus GBP37,607) with cost savings as a result of avoided diabetes-related complications entirely offsetting increased acquisition costs.  Versus lixisenatide, liraglutide was associated with increased costs (GBP37,520 versus GBP37,126), driven by increased acquisition costs which were partially offset by reduced costs of treatment of complications.  Based on the projected outcomes, liraglutide was found to be dominant over exenatide and associated with an incremental cost-effectiveness ratio of GBP7,367 per QALY gained versus lixisenatide.

CONCLUSIONS: Liraglutide 1.2mg is likely to be considered cost-effective or cost-saving versus alternative GLP-1 receptor agonists for treatment of diabetes in the UK.