Metformin forms the first-line therapy for patients with type 2 diabetes, but the majority require treatment intensification at some stage due to the progressive nature of the disease.  The 1860-LIRA-DPP4 trial showed that, at 52 weeks, liraglutide exhibited greater improvements compared with sitagliptin in HbA1c, blood pressure, serum lipids and BMI in patients with diabetes inadequately controlled on metformin monotherapy.  This study compared the long-term clinical and cost implications associated with liraglutide and sitagliptin for subjects with type 2 diabetes in Spain.

METHODS:

Data were taken from the 1860-LIRA-DPP4 trial randomized, controlled trial at 52 weeks, in which adults with type 2 diabetes were randomly allocated to receive either 1.8mg liraglutide or 100mg sitagliptin daily in addition to metformin.  Long-term (patient lifetime) projections of clinical outcomes and direct costs (2012 EUR) were made using a published and validated model of type 2 diabetes.  Outcomes were discounted at 3% annually.  Sensitivity analyses were performed and support the findings.

RESULTS:

Liraglutide was associated with improved clinical outcomes over sitagliptin in terms of life expectancy (14.24 versus 13.87 years) and quality adjusted life-expectancy (9.24 versus 8.84 quality-adjusted life years [QALYs]).  Improved clinical outcomes were driven by improved glycemic control, leading to a reduced incidence of diabetes-related complications, including renal disease, cardiovascular disease, ophthalmic and diabetic foot complications.  Liraglutide was associated with increased direct costs (EUR 56,628 versus EUR 52,450), driven by the acquisition cost of liraglutide.  However, this was partially offset by the reduced cost of treating diabetes-related complications.  Based on these estimates, liraglutide was associated with an incremental cost-effectiveness ratio of EUR 10,436 per QALY gained versus sitagliptin.

CONCLUSIONS:

Liraglutide 1.8mg was projected to improve clinical outcomes over sitagliptin as a result of reduced incidence of diabetes-related complications.  Liraglutide is likely to be cost-effective from a healthcare payer perspective in Spain.