The cost-effectiveness of exenatide twice daily (BID) vs insulin lispro three times daily (TID) as add-on therapy to titrated insulin glargine in patients with type 2 diabetes

Objective, To evaluate the cost-effectiveness of exenatide twice daily, BID, vs bolus insulin lispro three times daily, TID, as add-on therapy when glycemic control is sub-optimal with titrated basal insulin glargine and metformin. Methods, The analysis was based on the recent, B Study, which compared exenatide BID and lispro TID as add-on therapies in subjects with type, diabetes insufficiently controlled, despite titrated insulin glargine. The Cardiff Diabetes Model was used to simulate patient costs and health benefits beyond the, B Study. The Swedish healthcare perspective was adopted for this analysis, costs are reported in, EUR to aid interpretation. The main outcome measure was the cost per quality-adjusted life-year, QALY, gained with exenatide BID compared to lispro TID. Results, Exenatide BID was associated with an incremental cost of, and a QALY increase of, ., compared with lispro TID over, years. The cost per QALY gained with exenatide BID compared with lispro TID was, which is within conventional limits of cost-effectiveness. Cost-effectiveness results were generally robust to alternative assumptions and values for key model parameters. Limitations, Extrapolation of trial data over the longer term can be influenced by modeling and parameter uncertainty. Cost-effectiveness results were generally insensitive to alternative values of key model input parameters and across scenarios. Conclusions, The addition of exenatide BID rather than insulin lispro to basal insulin is associated with similar or better clinical outcomes. Illustrated from the Swedish healthcare perspective, analysis with the Cardiff Diabetes Model demonstrated that exenatide BID represents a cost-effective treatment alternative to lispro TID as add-on therapy in type, diabetes patients insufficiently controlled on basal insulin.J. Gordon, P. McEwan, U. Sabale, B. Kartman and B. H. R. Wolffenbutte

Real-world impact of rotavirus vaccination in European healthcare settings: a systematic literature review

Introduction: Rotavirus is one of the most common pathogens causing diarrhea in children <5 years and has a major impact on childhood morbidity and mortality. Since the implementation of rotavirus vaccines into childhood immunization programs across Europe, there has been a reduction in rotavirus burden, including hospitalizations, outpatient cases, costs, and deaths. Areas covered: A systematic literature review identified publications describing the clinical and economic impact of rotavirus vaccinations across Europe, from their introduction in 2006 to the end of 2020. A total of 3,137 articles were identified, of which 46 were included in the review. Included articles reported the impact of rotavirus vaccination on disease in any age group. Expert opinion: Rotavirus vaccination has resulted in substantial reductions in hospitalizations and rotavirus-associated costs across Europe, particularly in children <5 years. There is some evidence of herd protection afforded to older age groups where vaccine uptake is high among infants, highlighting the potential for vaccination to confer a greater societal benefit as programs become more established. Increasing vaccination coverage and continuing investment in widespread rotavirus vaccination programs across countries will likely increase the substantial public health benefits associated with vaccination and further reduce the clinical and economic burden of disease