COMPARATIVE CLINICAL AND ECONOMIC ANALYSIS OF THE INTENSIFICATION THERAPY IN PATIENTS WITH UNCONTROLLED DIABETES TYPE 2 USING BASAL INSULIN OR DAPAGLIFLOZIN
Abstract
Objective. Determine if dapagliflozin use is pharmacoeconomically reasonable option for patients with inadequate glycemic control compared with basal insulin.
Materials and Methods. The study was conducted according to standard pharmacoeconomic methods: cost-utility analysis (CUA), budget impact analysis (BIA).
Results. The use of dapagliflozin as an alternative to basal insulin can reduce health system costs, improves the quality of life of patients, adding 0.73 QALY per patient. Modelling suggests that dapagliflozin introduction could delay the start of insulin treatment by an average of 6.5 years that in turn will allow achieving cost savings and improving the quality of life of patients.
Conclusions. Dapagliflozin therapy is the preferred alternative to basal insulins, due to lower costs and improvement in the quality of life of patients.
About the Authors
V. I. Petrov
Volgograd State Medical University
Russian Federation
Russian Federation
MD, professor, academician, Rector,
Head of the Department of Clinical Pharmacology, Head Specialist of the Russian Federation Ministry of Health – Clinical Pharmacology,
Honored Doctor of the Russian Federation,
Square Pavshikh Bortsov, 1, Volgograd, 400131
S. V. Nedogoda
Volgograd State Medical University
Russian Federation
Russian Federation
MD, Professor, Head of Therapy and Endocrinology Faculty of Advanced Medical Studies,
Str. Tsiolkovsky, 1, Volgograd, 400001
M. Yu. Frolov
Volgograd State Medical University
Russian Federation
Russian Federation
PhD, associate professor Course HFC Department of Clinical Pharmacology,
Square Pavshikh Bortsov, 1, Volgograd, 400131
A. S. Salasyuk
Volgograd State Medical University
Russian Federation
Russian Federation
PhD, assistant chair of therapy and endocrinology Faculty of Advanced Medical,
Str. Tsiolkovsky, 1, Volgograd, Russia, 400001
I. N. Barykina
Volgograd State Medical University
Russian Federation
Russian Federation
PhD, assistant chair of therapy and endocrinology Faculty of Advanced Medical,
Str. Tsiolkovsky, 1, Volgograd, 400001
V. O. Smirnova
Volgograd State Medical University
Russian Federation
Russian Federation
graduate student of chair of therapy and endocrinology Faculty of Advanced Medical,
Str. Tsiolkovsky, 1, Volgograd, 400001
V. Yu. Khripaeva
Volgograd State Medical University
Russian Federation
Russian Federation
graduate student of chair of therapy and endocrinology Faculty of Advanced Medical,
Str. Tsiolkovsky, 1, Volgograd, 400001.
References
1. Algorithms specialized medical care to patients with diabetes mellitus. Ed. II Grandfathers MV Shestakova (7th edition) [Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. Pod red. I.I. Dedova, M.V. Shestakovoi (7-i vypusk) (In Russian)]. Sakharnyi diabet. 2015; 18 (1S): 1-112.
2. Dedov I.I. et al. Sakharnyi diabet. 2010; 1.
3. Dedov I.I. Vestnik Rossiiskoi akademii meditsinskikh nauk. 2012; 1.
4. Dedov I.I., Shestakova M.V., Vikulova O.K. Sakharnyi diabet. 2015; 18 (3): 5-22.
5. Dedov I.I., Shestakova M.V. Sakharnyi diabet. 2013; special issue: 5-6, 10-26, 32-34.
6. Kalashnikova M.F., Suntsov Yu.I., Belousov D.Yu., Kantemirova M.A. Sakharnyi diabet. 2014 ; 3: 5-16.
7. Petrov V.I., Sabanov A.V. undamentals of pharmacoepidemiology. Selected lectures of scientists Volgmu with aspects of evidencebased medicine [Osnovy farmakoepidemiologii Izbrannye lektsii uchenykh VolGMU s aspektami dokazatel'noi meditsiny (In Russian)]. Volgograd. 2008; 63-65.
8. Serdyukova D.M. Impact cost of the disease on the optimal choice of pharmacotherapy for type 2 diabetes. PhD diss. [Vliyanie stoimosti bolezni na optimal'nyi vybor farmakoterapii sakharnogo diabeta 2 tipa. Avtoreferat dis. … kand. med. nauk (In Russian)]. Volgograd. 2015; 24 s.
9. Suntsov Yu.I. Sakharnyi diabet. 2013; 2S.
10. Suntsov Yu.I., Dedov I.I. Sakharnyi diabet. 2005; 2: 2-6.
11. Shestakova M.V., Khalimov Yu.Sh., Novikov V.I. Klin farmakol terapiya. 2009; 18 (2): 92-96.
12. Yagudina R.I., Kulikov A.Yu., Serpik V.G. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / Pharmacoeconomics. Modern pharmacoeconomics and pharmacoepidemiology. 2009; 4: 10-13.
13. Clarke P., Gray A., Holman R. Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Medical Decision Making. 2002; 22 (4): 340-349.
14. Currie C.J. et al. The routine collation of health outcomes data from hospital treated subjects in the Health Outcomes Data Repository (HODaR): descriptive analysis from the first 20,000 subjects. Value in health. 2005; 8 (5): 581-590.
15. DeFronzo R.A., Eldor R., Abdul-Ghani M. Pathophysiologic approach to therapy in patients with newly diagnosed type 2 diabetes. Diabetes Care. 2013; 36 (2): 127-138.
16. Del Prato S. et al. Long-term glycaemic response and tolerability of dapagliflozin versus a sulphonylurea as add-on therapy to metformin in patients with type 2 diabetes: 4-year data. Diabetes, Obesity and Metabolism. 2015; 17 (6): 581-590.
17. Garber A. et al. Metformin-glibenclamide versus metformin plus rosiglitazone in patients with type 2 diabetes inadequately controlled on metformin monotherapy. Diabetes, Obesity and Metabolism. 2006; 8 (2): 156-163.
18. Gerstein H.C. et al. Basal insulin and cardiovascular and other outcomes in dysglycemia. The New England journal of medicine. 2012; 367 (4): 319-328.
19. Grandy S. et al. Health-related quality of life (EQ-5D) among type 2 diabetes mellitus patients treated with dapagliflozin over 2 years. International journal of clinical practice. 2014; 68 (4): 486-494.
20. Guariguata L. et al. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes research and clinical practice. 2014; 103 (2): 137-149.
21. IMS Health (2007): Medical Ambition II – Supplement: Extension to newly diagnosed patients, Basel Switzerland; In: Novo Nordisk S/A (2007) Changing Diabetes Barometer First Report, 63.
22. International Diabetes Federation. IDF Diabetes, 7 ed. Brussels, Belgium: International Diabetes Federation, 2015. http://www.diabetesatlas.org. Accessed: 17.01.16.
23. Matthaei S. et al. Dapagliflozin improves glycemic control and reduces body weight as add-on therapy to metformin plus sulfonylurea: a 24-week randomized, double-blind clinical trial. Diabetes Care. 2015; 38 (3): 365-372.
24. Oxford Outcomes. Societal and patient utilities for type 2 diabetes health states: A Canadian, Australian and United Kingdom perspective, Final Report, August 12, 2011.
25. Pfohl M. et al. Effectiveness and tolerability of treatment intensification to basal-bolus therapy in patients with type 2 diabetes on previous basal insulin-supported oral therapy with insulin glargine or supplementary insulin therapy with insulin glulisine: the PARTNER observational study. Vascular health and risk management. 2015; 11: 569.
26. Ptaszynska A. et al. Effects of dapagliflozin on cardiovascular risk factors. Postgraduate medicine. 2013; 125 (3): 181-189.
27. Rao A.D. et al. Is the combination of sulfonylureas and metformin associated with an increased risk of cardiovascular disease or allcause mortality? A meta-analysis of observational studies. Diabetes care. 2008; 31 (8): 1672-1678.
28. Russell-Jones D. et al. Liraglutide vs insulin glargine and placebo in combination with metformin and sulfonylurea therapy in type 2 diabetes mellitus (LEAD-5 met+ SU): a randomised controlled trial. Diabetologia. 2009; 52 (10): 2046-2055.
29. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998; 352: 854-865.
30. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998; 352: 837-853.
For citation:
Petrov V.I., Nedogoda S.V., Frolov M.Yu., Salasyuk A.S., Barykina I.N., Smirnova V.O., Khripaeva V.Yu. COMPARATIVE CLINICAL AND ECONOMIC ANALYSIS OF THE INTENSIFICATION THERAPY IN PATIENTS WITH UNCONTROLLED DIABETES TYPE 2 USING BASAL INSULIN OR DAPAGLIFLOZIN. FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology. 2016;9(1):58-68. (In Russ.) https://doi.org/10.17749/2070-4909.2016.9.1.058-068
Views: 801
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 