The key challenges in the successful treatment of type 2 diabetes include maintaining tight glycemic control, minimizing the risk of hypoglycemia, controlling cardiovascular risk factors, and controlling body weight.  The aim of the present analysis was to evaluate the cost per patient achieving a composite clinical endpoint (HbA1c < 7%, with no weight gain and no hypoglycemic events) in patients with type 2 diabetes in Canada receiving liraglutide 1.2 mg, liraglutide 1.8 mg, thiazolidinedione, sulfonylurea, insulin glargine, sitagliptin or exenatide.

METHODS:

The proportion of patients achieving control was taken from a meta-analysis of the phase 3 trial program of liraglutide.  Treatment costs were estimated from a healthcare payer perspective.  Cost-effectiveness in terms of cost per patient achieving the composite endpoint (cost of control) was evaluated with an economic model developed in Microsoft Excel.  No discounting was applied to cost or clinical outcomes as these were not projected beyond a 1-year time horizon.  Sensitivity analyses were performed.

RESULTS:

Liraglutide 1.8 mg was associated with the lowest number needed to treat to bring one patient to the composite endpoint.  Evaluation of only annual pharmacy costs indicated that was associated with the lowest direct annual costs.  Combining the clinical efficacy data with the annual cost of medications produced cost of control values of CAD 6,070 (liraglutide 1.2 mg), CAD 6,949 (liraglutide 1.8 mg), CAD 7,237 (glimepiride), CAD 7,704 (exenatide), CAD 8,297 (insulin glargine), CAD 8,741 (pioglitazone) and CAD 9,270 (sitagliptin) per patient achieving the composite endpoint.

CONCLUSIONS:

Liraglutide 1.2 mg and 1.8 mg were associated with the lowest cost of control values, driven by the high proportion of patients achieving the composite endpoint.  A relatively low cost of control value was achieved for glimepiride, driven by low acquisition costs, despite relatively few patients achieving the composite endpoint.