Inpharma 1607 - 29 Sep 2007

Pharmacoeconomics news from EASDAmsterdam, The Netherlands September 2007

associated with improved glycaemic control, decreasedPioglitazone good value for Swisshypoglycaemic events, and fewer diabetes-relatedPioglitazone is a "cost-effective treatment option" andcomplications than NPH insulin."represents good value for money" in the Swiss setting

These favourable clinical outcomes would translatedfor patients with type 2 diabetes mellitus at high risk ofinto increased life expectancy and lower costsfurther cardiovascular (CV) events, according to a[see table]. The model’s results were found to be "stablemultinational group of researchers.1

under variation in a range of reasonable assumptions",Using the validated CORE Diabetes Model populatedthe investigative team asserts.with Swiss data, the researchers ascertained that

pioglitazone would generate an incremental cost- Rimonabant cuts the mustard in UK obeseeffectiveness ratio (ICER) of SwF60 596 per QALY "Meaningful reductions" in disease and overweightgained versus placebo over a lifetime horizon.* This can be attained with rimonabant at "reasonable costs" infigure is estimated from the extra 0.180 QALYs the the UK for obese patients with diabetes, a multinationalmodel projected pioglitazone would gain per patient research team contends.3versus placebo. Patient-level data obtained from the The addition of rimonabant 20 mg/day to patients’PROspective pioglitAzone Clinical Trial In existing antidiabetic treatments and a diet and exercisemacroVascular Events (PROactive) study were regimen was evaluated using a discrete eventimbedded in the model, with 18 relevant disease and simulation. After 1 year of rimonabant treatment,procedure-specific interdependent Markov sub-models patients would achieve a mean weight loss of > 3kgincorporated to extrapolate costs and effects beyond the more than with diet and exercise alone. Moreover,timeframe of the trial. rimonabant recipients would achieve mean HDL-

Costs associated with treatment, management and cholesterol increases of 0.11 mmol/L and triglyceridecomplications were derived from published Swiss decreases of 0.33 mmol/L, while those on diet andsources, and all clinical and economic outcomes were exercise alone would "experience little change in lipiddiscounted at a rate of 2.5% per annum. levels", notes the research team. Furthermore, while

38% of patients would have HbA1c levels of > 7% atLife expectancy pans outbaseline, rimonabant treatment would reduce thisWhen added to existing diabetes and CV therapiesproportion to 20%, compared with 30% for diet and(including statins), pioglitazone was projected toexercise alone.increase life expectancy by 0.258 years, compared with

Over a lifetime, 1000 patients treated withplacebo, at an additional cost of SwF10 914 per patient;rimonabant for 5 years would avoid 45 CV events and 38this would lead to an ICER of SwF42 274 per life-yearmicrovascular complications, with an increased quality-gained. Probabilistic sensitivity analysis showed thatadjusted survival of 320 years, versus diet and exercisepioglitazone would be cost effective with 62.5%alone. The research team points out that, at a cost ofprobability, assuming a willingness-to-pay value of£1.97 per day, rimonabant would have an ICER of £8700SwF80 000 per QALY gained.per discounted QALY versus diet and exercise alone.

Insulin detemir well worth it in SpainRosiglitazone cost saving vs sulfonylureasInsulin detemir represents "excellent value for money"

Rosiglitazone use is associated with annual total costin Spain, with an ICER of < €25 000 per QALY gainedsavings of $US1296 per type 2 diabetes patient,versus NPH insulin, contends a group of investigatorscompared with sulfonylurea use, shows a studyfrom Europe.2

conducted by US-based researchers and supported byThey too used the CORE Diabetes Model to processGlaxoSmithKline.4

their data, applying cohort characteristics of patientsDuring ≥ 60 days of treatment, rosiglitazonefrom a meta-analysis of three clinical trials in type 1

recipients (n = 3377) incurred significantly less frequentdiabetes patients. The two treatments considered in theinpatient and outpatient visits and hospital-days thaneconomic analysis were insulin detemir and neutralsulfonylurea recipients (11 778):protamine hagedorn (NPH) insulin, each used in• 0.47 vs 0.77 visitscombination with either insulin aspart or human soluble• 17.0 vs 17.9 visitsinsulin as the bolus component of therapy. Novo• 1.6 vs 2.9 days, respectively.Nordisk supported the study; one of the investigatorsConsequently, costs associated with inpatient andwas affiliated with this company.

outpatient visits were lower for rosiglitazone versussulfonylurea recipients ($US717 vs $US1046 per patient

Per-patient health economic outcomes per month), although prescription costs were higherInsulin detemir NPH insulin ($US348 vs $US270 per patient per month, p < 0.001).

The overall significant cost saving observed withCosts and outcomesa

rosiglitazone relative to sulfonylurea would "transpireLife expectancy (years) 14.42 14.33into a considerable impact on the health care systemQALYs gained 7.21 7.04given the high prevalence of diabetes", the researchersDirect costs (€) 53 545 49 291affirm.ICER (cost/QALY 24 616

gained €) Thiazolidinediones spare MCOs’ budgets . . .a discounted at 3.5% per annum "Significantly better economic outcomes" were

observed among patients with type 2 diabetes uponaddition of a thiazolidinedione versus insulin toAccording to the model, insulin detemir would be

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Inpharma 29 Sep 2007 No. 16071173-8324/10/1607-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Single Article

sulfonylurea therapy, state US-based investigators.5 US database for patients with type 2 diabetes whoIndeed, the study’s** findings demonstrate that the received add-on therapy to metformin with either a

addition of a thiazolidinedione to oral sulfonylurea thiazolidinedione (n = 1153) or insulin (455).**

therapy was associated with a significant 22% decrease Unadjusted total 2-year follow-up costs werein total healthcare costs versus add-on therapy with significantly lower among thiazolidinedione than insulininsulin. The researchers used an integrated medical and recipients ($US17 339 vs $US21 150 per patient).pharmacy claims database to extract data for Moreover, this difference persisted after adjusting for994 patients with type 2 diabetes initiated on either differences in baseline characteristics, note thethiazolidinedione (n = 610) or insulin add-on to researchers.sulfonylurea therapy. * Costs were reported in 2005 Swiss francs, and the analysis was

Evaluation of the economic impact of such therapy supported by Takeda, with which two of the researchers wereaffiliated.add-ons to a US managed care organisation’s (MCO)

budget showed that overall per member per month ** supported by GlaxoSmithKline; one of the researchers was affiliatedwith that company(PMPM) pharmacy costs would be lower for the

thiazolidinedione group versus the insulin group 1. Brandle M, et al. Cost-effectiveness of pioglitazone in type 2 diabetes inSwitzerland based on the PROactive study. Diabetologia 50 (Suppl. 1): 428($US262 vs $US360, p < 0.01). However, despite(plus poster) abstr. 1034, Sep 2007.diabetes-related pharmacy costs being greater in the 2. Ray JA, et al. Cost-effectiveness of detemir based basal-bolus therapy versus

thiazolidinedione group versus the insulin group NPH for type 1 diabetes in a Spanish setting. Diabetologia 50 (Suppl. 1): 428(plus poster) abstr. 1033, Sep 2007.($US109.4 vs $US96.1), cost savings of $US96 PMPM

3. Getsios D, et al. Treatment with rimonabant for overweight or obese patientswere still realised for the thiazolidinedione group. with diabetes: health economic estimates for the UK. Diabetologia 50 (Suppl. 1):345 (plus poster) abstr. 0836, Sep 2007.. . . and reduce costs vs insulin add-on 4. Duh MS, et al. Comparison of resources utilization and cost in drug-naive type 2diabetes patients treated with rosiglitazone vs. sulfonylurea monotherapy.Thiazolidinedione use was also shown to significantlyDiabetologia 50 (Suppl. 1): 358 (plus poster) abstr. 0867, Sep 2007.reduce costs versus insulin when used as add-on 5. Balu S, et al. Economic analysis of thiazolidinedione add-on therapy relative to

therapy to metformin monotherapy.6 The study’s US- insulin add-on therapy in individuals treated with sulfonylureas: a third partypayer’s perspective. Diabetologia 50 (Suppl. 1): 358 (plus poster) abstr. 0868,based authors comment that these findings indicate thatSep 2007.selecting a thiazolidinedione as the second antidiabetic 6. Arondekar B, et al. Economic impact of add-on therapy with thiazolidinedioneversus insulin to metformin monotherapy. Diabetologia 50 (Suppl. 1): 358-359agent "can have an important economic impact on(plus poster) abstr. 0869, Sep 2007.healthcare costs for type 2 diabetes".

801069989Administrative claims data were obtained from a large

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