Stynes, G

Tilden, D

Swift, M

Cockle, S

Haycox, A

Aristides, M

Àrea de Prevenció, Seguretat i Mobilitat

Repositori Obert de Coneixement de l'Ajuntament de Barcelona

GUB : revista de la Guàrdia Urbana de Barcelona. Núm. 37 (oct. 2010)

G Stynes

D Tilden

M Swift

S Cockle

A Haycox

M Aristides

Crossref

Value in Health

PDB10 THE COST-EFFECTIVENESS OF PIOGLITAZONE IN COMBINATION WITH METFORMIN IN THE TREATMENT OF TYPE 2 DIABETES MELLITUS IN SCOTLAND

GUB : revista de la Guàrdia Urbana de Barcelona. Núm. 34 (des. 2009)

Elsevier - Publisher Connector 

737Abstracts
OBJECTIVES: A recent randomized trial demonstrated that
twice daily biphasic insulin aspart 30/70 (BIAsp30/70) led to sig-
niﬁcantly (p = 0.0057) better glycaemic control compared to
bedtime insulin glargine in insulin-naïve type-2 diabetes patients
on oral antidiabetics (HbA1c reduced by -2.79% vs. -2.36%
from baseline). Patients gained more weight with BIAsp30/70
than with glargine (5.4 vs. 3.5kg, p = 0.0013), but weight gain
per unit insulin was similar. The CORE Diabetes Model, a peer-
reviewed, validated, model was used to project the long term cost
effectiveness of BIAsp30/70 versus glargine. METHODS: The
CORE Diabetes model employs standard Markov/Monte Carlo
simulation techniques to describe the long-term incidence and
progression of diabetes-related complications. Transition proba-
bilities were derived from major diabetes studies. Clinical effects
of comparators were derived from the INITIATE study. The
analysis was performed using published country-speciﬁc costs,
health care resource utilization and clinical data, and recom-
mended discount rates. A lifetime horizon and payers’ perspec-
tive was taken. Only direct costs were considered. Sensitivity
analyses were performed. RESULTS: Discounted quality-
adjusted life years (QALY) were improved by 0.13–0.25 years
with BIAsp30/70 versus glargine depending on country-speciﬁc
discount rates. Lifetime cost savings were observed 
with BIAsp30/70 in the Danish, Dutch, Finnish, French, Nor-
wegian, Spanish, and Swedish settings. Overall costs were
increased with BIAsp30/70 versus glargine in the German and
UK settings, with incremental cost-effectiveness ratios of 3692€
and £1541/QALY gained respectively. Results were most sensi-
tive to changes in baseline HbA1c and to the relative costs of
BIAsp30/70 versus glargine. CONCLUSIONS: Improvements in
glycemic control outweighed the greater increase in body weight,
leading to improved quality-adjusted life expectancy with
BIAsp30/70 versus glargine. BIAsp30/70 was projected to lead
to overall cost savings or would be considered cost-effective
versus glargine, with costs/QALY falling well below commonly
accepted international thresholds.
PDB8
WILL IRBESARTAN LEAD TO COST SAVINGS DUE TO
DELAYED END STAGE RENAL DISEASE IN HYPERTENSIVE
TYPE-2 DIABETICS IN GERMANY?
Pirk O1, Ratzmann KP2, Carels J3, Bramlage P4, Kirch W4
1Fricke & Pirk GmbH, Nuremberg, Germany; 2Diabetische
Schwerpunktpraxis, Berlin, Germany; 3Sanoﬁ-Synthelabo, Berlin,
Germany; 4Medizinische Fakultaet Carl Gustav Carus der Technischen
Universitaet Dresden, Dresden, Germany
OBJECTIVES: Type-2 diabetes is a major health problem. 30%
of all patients being on dialysis suffer from a diabetic Endstage
Renal Disease (ESRD). The Angiotensin-2-Receptor-Blocker
(ARB) Irbesartan has proven its capability to prevent or delay
an ESRD. Based on the results of the multicentre double-blind,
randomized, placebo-controlled Irbesartan Diabetic Nephropa-
thy Trial (IDNT) the presented study aims to show that a treat-
ment of renal diseases in hypertensive type-2 diabetics with the
ARB Irbesartan is cost saving for the German health care system.
METHODS: A cost-effectiveness analysis from the German
payers’ perspective was conducted taking direct costs into
account. 1715 type-2 diabetics with hypertension and limited
renal function were included in IDNT (2.6 years, subgroup with
300mg/d Irbesartan). The patient number needed to treat (NNT)
to prevent one ESRD was the efﬁcacy parameter for this analy-
sis. Public sources were used for cost data and information on
dialysis and transplantation in diabetics with ESRD. Actual drug
prices were used taking into account discounts and co-payments
effective in Germany due to new legislation since January 2004.
Due to conservative calculation no discounting was performed,
follow-up treatment costs were not included. RESULTS: The
NNT for the primary endpoint ESRD calculated to 28 during
the study period of 2.6 years in IDNT. That means additional
treatment costs of €25,007.—lead to one prevented ESRD (incre-
mental cost-effectiveness-ratio). The prevented ESRD (82% dial-
ysis, 18% transplantation) is worth €45,766.—which shows a
beneﬁt for Irbesartan treatment of €20,758.—after 2.6 years or
€7984.—per year assuming a linear trend towards delay in
ESRD. A sensitivity analysis stated the robustness of the data.
CONCLUSIONS: Based on epidemiologic data our results
suggest savings for the German health care system of €3.2 billion
after 2.6 years if annually additional €681 million were invested
in the treatment of type-2 diabetics with Irbesartan.
PDB9
THE VALUE OF ORAL MONOTHERAPY ALTERNATIVES IN THE
FIRST-LINE TREATMENT OF TYPE-2 DIABETES MELLITUS
Tilden D1, Stynes G1, Swift M2, Cockle S1, Haycox A3, Aristides M1
1M-TAG Limited, Hammersmith, UK; 2Takeda UK Limited, High
Wycombe, UK; 3University of Liverpool, Liverpool, UK
OBJECTIVES: To construct a lifetime model evaluating poten-
tial health beneﬁts and costs applying to Scottish Type-2 diabetes
mellitus patients initiating ﬁrst-line oral monotherapy, for whom
metformin is inappropriate because of contra-indications or
intolerance. When lifestyle modiﬁcation (diet and exercise)
affords inadequate glycaemic control, these patients currently
have no alternative to sulphonylurea (SU) therapy. The model
compared novel agent pioglitazone (PIO) versus generic SU treat-
ment. METHODS: A decision-analytic Markov model was 
constructed using published (UKPDS) cost data for diabetes
management and co-morbidity treatment. Three prospective
treatment pathways were explored: ﬁrst-line PIO/second-line
PIO + SU combination/third-line insulin; ﬁrst-line SU/second-
line PIO + SU combination/third-line insulin; and ﬁrst-line
SU/second-line insulin. The model incorporated efﬁcacy evidence
of glycaemic control under PIO and SU, measured as initial
HbA1c improvements and the rate of disease progression in
terms of HbA1c (the coefﬁcient of failure). RESULTS: Patients
treated with PIO achieved better HbA1c control and improved
serum lipid proﬁles, which translated into fewer diabetic com-
plications, better quality of life and improved overall survival.
Additional drug costs of PIO over SU were partly offset by lower
costs to treat and manage diabetes complications, and delayed
insulin therapy. The estimated incremental cost per QALY gained
of PIO was £2415 compared to SU (when followed by second-
line PIO/SU and third-line insulin therapy). The incremental cost
per QALY gained of PIO was £1514 compared to SU (when fol-
lowed by second-line insulin therapy). CONCLUSIONS: Clini-
cal trial evidence indicated superior glycaemic (HbA1c) control
in patients treated with PIO, in comparison with those treated
with SU. The model showed that PIO is a cost-effective inter-
vention and thus a valuable addition to ﬁrst-line treatment
options for patients intolerant and/or contra-indicated to met-
formin. Importantly, initiating PIO as second-line combination
treatment after ﬁrst-line SU in this patient group was less efﬁ-
cient than providing PIO monotherapy in a ﬁrst-line setting.
PDB10
THE COST-EFFECTIVENESS OF PIOGLITAZONE IN
COMBINATION WITH METFORMIN IN THE TREATMENT OF
TYPE 2 DIABETES MELLITUS IN SCOTLAND
Stynes G1,Tilden D1, Swift M2, Cockle S1, Haycox A3, Aristides M1
1M-TAG Limited, Hammersmith, UK; 2Takeda UK Limited, High
Wycombe, UK; 3University of Liverpool, Liverpool, UK
OBJECTIVES: To develop a lifetime model of Type-2 diabetes
mellitus and its sequelae, to compare the costs and beneﬁts of
738 Abstracts
pioglitazone plus metformin (PIO + MET) versus sulphonylurea
plus metformin (SU + MET) oral combination therapies in
patients with insufﬁcient glycaemic control despite maximal tol-
erated dose of metformin monotherapy. METHODS: A decision-
analytic model employing a Markov process was constructed
using TreeAge DATA. The model incorporated efﬁcacy evidence
from a key clinical trial comparing the glycaemic control of PIO
+ MET versus SU + MET, as measured by initial improvements
in HbA1c and the rate of disease progression in terms of HbA1c
(the coefﬁcient of failure). Treatment pathways reﬂecting best
practice in Scotland, including third-line insulin therapy, were
modelled, with published (UKPDS) cost data of diabetes man-
agement and co-morbidity treatment. RESULTS: Patients treated
with PIO + MET achieved better HbA1c control and improved
serum lipid proﬁles, which translated into fewer diabetic com-
plications, better quality of life and improved overall survival.
Additional drug costs of PIO + MET over SU + MET were partly
offset by lower costs to treat and manage diabetes complications,
and delayed third-line insulin therapy. PIO + MET patients
incurred mean additional costs of £1217 per patient and gained
0.05 additional quality-adjusted life years (QALY’s) per patient
compared to SU + MET patients. The estimated incremental cost
per QALY gained of PIO + MET compared to SU + MET was
£25,599. If a QALY is valued at £30,000, PIO + MET is asso-
ciated with a net health beneﬁt of £209 per patient (95% 
conﬁdence interval: -£6679 to £8076). CONCLUSIONS: The
relationship between HbA1c and the incidence of complications
in Type-2 diabetes is well established. Evidence from a large
head-to-head trial indicates superior glycaemic (HbA1c) control
accompanied by signiﬁcantly improved serum lipid proﬁles in
patients treated with PIO + MET. Given that PIO + MET pro-
vides a positive net health beneﬁt, therefore PIO + MET is a cost-
effective intervention relative to current treatment in Type-2
diabetes.
PDB11
PHARMACOECONOMIC ASPECTS OF USE OF INSULIN
GLARGINE IN TREATMENT OF DIABETES MELLITUS TYPE 2
(DM T2) IN RUSSIA
Suntsov YI, Dedov II, Komarova VP,Vedeneeva LF
Endocrinology Research Center, Moscow, Russia
OBJECTIVES: To conduct a prognostic evaluation of the total
cost of treatment of DM T2 and its complications, to estimate
the economic effectiveness of the use of insulin glargine.
METHODS: At stage 1, the costs of treatment of 500 patients
in DM T2 from 15 regions of Russia were studied. At stage 2,
the predicted prevalence of complications over 10-year time
interval and their cost was calculated by the Diabetes Mellitus
Model (DMM) using. At stage 3, the total cost of treatment of
DM T2 patients in Russia based on the State Register of Dia-
betes Patients at the moment of the study and prospectively at
the 10th year from the start was calculated. The method of cash
ﬂow discounting according to the formula á = 1/(1 + ri)i was
used, where á is the discounting coefﬁcient, i is the consecutive
number of the period, and ri is the discounting rate in the i-th
period in fractions of a unit. RESULTS: According to data of
previous comparative studies, the use of insulin glargine leads to
reach a lower level of HbA1c versus NPH insulins, and this dif-
ference amounts to 0.85%. Taking into account these data,
decreases in the predicted prevalence at the end of the 10-year
period pro-vided that insulin glargine was used, in comparison
to NPH insulin, would amount to 18% for mi-crovascular com-
plications, 25% for chronic renal insufﬁciency, 10% for
macrovascular complica-tions, 13% for myocardial infarction;
22% for diabetic foot syndrome, and 12% for mortality. The
annual costs of treatment of complications in DM T2 patients
in Russia should decrease by US$246.7 million. CONCLU-
SIONS: The use of the human insulin analogue insulin glargine
in treatment of DM T2 patients allows the cost of treatment to
be decreased mainly due to a decrease in expenditures on treat-
ment of complications.
PDB12
COSTS OF TYPE-2 DIABETES MELLITUS: A COMPARISON
BETWEEN DIABETIC AND NON-DIABETIC SUBJECTS
Perelli Cippo P, Scalone L, Mantovani LG
University of Milan, Milan, Italy
OBJECTIVES: Type-2 diabetes mellitus is a common chronic
disease and a costly health care problem. The aims of this study
were to assess the social costs of type-2 diabetes mellitus and to
evaluate the costs of diabetic patients in comparison with non-
diabetic subjects. METHODS: We conducted a Cost of Illness
(COI) analysis from a societal perspective with a 3-month time
horizon. Data were collected from a population based natural-
istic prospective survey, designed to investigate cardiovascular
risk factors in a sample of the Italian general population aged
from 40 to 79 years. We selected all type-2 diabetic patients and
we matched each of them by age and sex with a non-diabetic
subject. Patients were interviewed by general practitioners about
clinical/demographic characteristics, medical resource utilization
and absence from work during the 3 months before the enrol-
ment visit. Direct medical costs were quantiﬁed including hospi-
talizations, drug therapies, specialist visits, diagnostics and
laboratory exams, while indirect costs were estimated based 
on productivity losses with the Human-Capital-approach.
RESULTS: We studied 666 patients, 333 with type-2 diabetes
matched with 333 without the disease. The mean total cost per
patient-month was 228.7€ compared to 169.9€ for patients with
and without type-2 diabetes mellitus, respectively (P < 0.0001).
On average, direct medical cost per patient-month was estimated
at 199.2€ in diabetic patients and 129.1€ in non-diabetic sub-
jects (P < 0.0001). Hospitalizations accounted for the greatest
proportion of health care costs in both groups, followed by drug
therapies (hospitalizations: 65.1% and 59.6%; drug therapies:
24.5% and 29.7% in patients with and without type-2 diabetes,
respectively). There was no statistically signiﬁcant difference in
indirect costs between diabetic and non-diabetic subjects. CON-
CLUSIONS: The results show that type-2 diabetes mellitus
patients aged from 40 to 79 years are more costly than non-
diabetic subjects.
PDB13
ECONOMIC EVALUATION OF THE STEPPED VERSUS
ORDINARY CARE FOR PREVENTION OF TYPE-2 DIABETES IN
THE JDPP: JAPAN DIABETES PREVENTION PROGRAM
Yanagisawa S1, Shimaya M1, Nakahara N1, Kamae I1, Kuzuya H2
1Kobe University, Kobe, Japan; 2National Hospital Organization Kyoto
Medical Center, Kyoto, Japan
OBJECTIVES: To perform an economic evaluation for the
primary prevention of typeII diabetes based on the intermediate
report of JDPP. METHODS: At ﬁrst, SF36(V.1.20) and EQ-5D
with Japanese version were applied, surveying over 205 partici-
pants, to assess whether or not the stepped care in JDPP may
change the QOL of the patients with the relevant symptoms of
silence. The second, a decision-analytic model was used to
combine transition probabilities with clinical stages of diabetes,
resource use and cost data in the framework of cost-effectiveness
analysis within three years since 1998. The model employed a
societal perspective to estimate the expected costs for each group
of the stepped vs. ordinary cares which included the direct costs


PDB10 THE COST-EFFECTIVENESS OF PIOGLITAZONE IN COMBINATION WITH METFORMIN IN THE TREATMENT OF TYPE 2 DIABETES MELLITUS IN SCOTLAND 

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PDB10 THE COST-EFFECTIVENESS OF PIOGLITAZONE IN COMBINATION WITH METFORMIN IN THE TREATMENT OF TYPE 2 DIABETES MELLITUS IN SCOTLAND

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