Cost-Effectiveness of Saxagliptin versus Acarbose as Second-Line Therapy in Type 2 Diabetes in China

<div><p>Objective</p><p>This study assessed the long-term cost-effectiveness of saxagliptin+metformin (SAXA+MET) versus acarbose+metformin (ACAR+MET) in Chinese patients with type 2 diabetes mellitus (T2DM) inadequately controlled on MET alone.</p><p>Methods</p><p>Systematic literature reviews were performed to identify studies directly comparing SAXA+MET versus ACAR+MET, and to obtain diabetes-related events costs which were modified by hospital surveys. A Cardiff Diabetes Model was used to estimate the long-term economic and health treatment consequences in patients with T2DM. Costs (2014 Chinese yuan) were calculated from the payer’s perspective and estimated over a patient’s lifetime.</p><p>Results</p><p>SAXA+MET predicted lower incidences of most cardiovascular events, hypoglycemia events and fatal events, and decreased total costs compared with ACAR+MET. For an individual patient, the quality-adjusted life-years (QALYs) gained with SAXA+MET was 0.48 more than ACAR+MET at a cost saving of ¥18,736, which resulted in a cost saving of ¥38,640 per QALY gained for SAXA+MET versus ACAR+MET. Results were robust across various univariate and probabilistic sensitivity analyses.</p><p>Conclusion</p><p>SAXA+MET is a cost-effective treatment alternative compared with ACAR+MET for patients with T2DM in China, with a little QALYs gain and lower costs. SAXA is an effective, well-tolerated drug with a low incidence of adverse events and ease of administration; it is anticipated to be an effective second-line therapy for T2DM treatment.</p></div

Demographic and Risk Factors.

<p>Demographic and Risk Factors.</p

Annual Direct Medical Costs for Diabetes-Related Complications (2014 Chinese Yuan).

<p>Annual Direct Medical Costs for Diabetes-Related Complications (2014 Chinese Yuan).</p

Base Case Results for Saxagliptin plus Metformin Compared with Acarbose plus Metformin (2014 Chinese yuan).

<p>Base Case Results for Saxagliptin plus Metformin Compared with Acarbose plus Metformin (2014 Chinese yuan).</p

Flow diagram of literature review.

<p>A detailed flow diagram that depicts search and selection processes.</p

Clinical Input Variables.

<p>Clinical Input Variables.</p

Tornado diagram of the univariate sensitivity analysis.

<p>Tornado diagram of the univariate sensitivity analysis.</p

Simulated progression of SBP in the treatment (saxagliptin+metformin) and control (acarbose+metformin) arms over the modeled time horizon.

<p>Simulated progression of SBP in the treatment (saxagliptin+metformin) and control (acarbose+metformin) arms over the modeled time horizon.</p

BMI-Related Prescription Costs (2014 Chinese yuan) ^a^, ^b.

<p>BMI-Related Prescription Costs (2014 Chinese yuan) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0167190#t005fn002" target="_blank">^a</a>^, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0167190#t005fn003" target="_blank">^b</a>.</p

Sensitivity Analyses for Saxagliptin plus Metformin versus Acarbose plus Metformin, Results per Patient (2014 Chinese yuan).

<p>Sensitivity Analyses for Saxagliptin plus Metformin versus Acarbose plus Metformin, Results per Patient (2014 Chinese yuan).</p