LIRAGLUTIDE VS. EXENATIDE IN COMBINATION WITH METFORMIN AND/OR SULFONYLUREA THERAPY IN TYPE 2 DIABETES MELLITUS THERAPY IN BULGARIA. A MODELLING STUDY

作者：Petrova Guenka^*; Ivanova Anna; Czech Marcin; Valov Vasil; Wrona Witold; Niewada Maciej; Savova Alexandra

来源：Comptes Rendus de l Academie Bulgare des Sciences, 2011, 64(10): 1507-1514.

• diabetes
• CORE diabetes model
• liraglutide
• exenatide
• cost-effectiveness
• pharmacoeconomic

The objective of this study was to conduct an economic evaluation of liraglutide combined with metformin (MET) and/or sulfonylurea therapy (SU) in comparison with exenatide in combination with MET and/or SU therapy in type 2 diabetes not adequately controlled with MET and/or SU. The study was conducted with respect to conditions of the Bulgarian health care system, from the perspective of the health care services payer and included only direct medical costs and benefits.
Cost-effectiveness economic analysis was applied to calculate the cost per quality adjusted life year (cost/QALY) and the cost per life year gained (cost/LYG), after modelling the cost of therapy and results from the clinical trial.
In this model, the Bulgarian cost data were used and therapeutic practice analysis was performed. Clinical results were based on the LEAD 6 trial, patients demographics and health state utility values were used as default values determined by the CORE diabetes model. Health state utility values for disease and treatment-related outcomes were used to determine quality-adjusted life years (QALYs).
In the base case analysis, the total cost of therapy with liraglutide was higher than that with exenatide, but the complications cost was lower, which could be attributed to better haemoglobin A1c (HbA1c) control. Life expectancy and QALYs increased with liraglutide (1.8 mg ones per day) by 0.129 (SD 0.175) and 0.151 (SD 0.124) years, respectively. Total costs increased by 4151 Bulgarian Levs (BGN) resulting in an incremental cost per LYG of BGN 32 082 and incremental costs per QALY gained of BGN 27 404.
The cost-effectiveness acceptability curves show that liraglutide (1.8 mg) can be considered a cost-effective treatment option compared to exenatide, with 71% probability of being a cost-effective treatment approach if the willingness to pay threshold is BGN 50 000 (based on QALY).
Liraglutide (1.8 mg) has been shown to be cost effective when compared to exenatide for the treatment of type 2 diabetes if the hypothetical willingness to pay threshold is approximately BGN 50 000 per QALY.

• 出版日期2011