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Фармакоэкономический анализ использования лираглутида в составе комбинированной терапии в лечении сахарного диабета 2-го типа

Abstract

The analysis goal is to determine the cost-effectiveness of liraglutideas add-on to metformin in for patients with type 2 diabetes in condition of the Russian health care system. Total medical expenses and effectiveness in terms of QALY are compared for liraglutide, glimepiride and rosiglitazone, all in combination with metformin, and metformin monotherapy. Methods: Data were sourced from a clinical trial comparing liraglutide vs. glimepiride (in combination with metformin), and a clinical trial comparing liraglutide vs. rosiglitazone (as add-on to metformin). From them data on clinical effectiveness in form of impact on HbA1(c), body mass index and blood pressure are extracted. Utility values are mostly taken from the UK Prospective Diabetes Studies supplemented with other published sources. The analysis is conducted from the perspective of the Russian health care system. Respectively the cost of the following resources is accounted: comparing of alternatives, concomitant pharmacotherapy, cost of medical manipulation, cost of ambulatory visits. Both future costs and clinical benefits are discounted at 3 percent. Sensitivity analysis is performed. Results of this analysis are shown in the incremental cost-utility rate (ICUR). Results: the data of the analysis illustrates that liraglutide therapy for type 2 diabetes patients provides a significant health improvement from the perspective of quality adjusted life-years. Simultaneously liraglutide demonstrates better cost-effectiveness than the compared alternatives. The ICUR index of 1.2 mg liraglutide in combination with metformin equal to 1 348368 rub, 1 161874 rub and 537331 rub for QALY in comparison with metformin monotherapy, glimepiride and rosiglitazone, both in combination with metformin, respectively. Conclusions: liraglutide 1,2 mg has turned to be cost-effective therapeutic alternative for treatment of type 2 diabetes in adult patients in conditions of Russian health care system over a 10-year time horizon.

About the Authors

A. Yu. Kulikov
First Moscow State Medical University named after I.M. Sechenov
Russian Federation

MD, PhD, Key scientific specialist of the Laboratory of pharmacoeconomic researches, Head of the pharmacoeconomics course of department of organization of medicinal provision and pharmacoeconomic
First Moscow State Medical University named I.M. Sechenov. Moscow, Russia tel: +7 (926) 800-10-56



I. V. Novikov
First Moscow State Medical University named after I.M. Sechenov
Russian Federation


References

1. Приказ МЗ РФ «Стандарт медицинской помощи больным с сахарным диабетом» от 18 января 2013 года.

2. Ягудина Р.И., Куликов А.Ю., Нгуен Т. Определение «порога готовности платить» в России, в Европейских странах и в странах СНГ. Фармакоэкономика. 2011; 1: 7-12

3. Ягудина Р.И., Сороковиков И.В. Методология проведения анализа «затраты-полезность» при проведении фармакоэкономических исследований. Фармакоэкономика. 2012; 2: 9-12.

4. Adler A.I., Stratton I.M., Neil H.A.W., Yudkin J.S., Matthews D.R., Cull C.A. et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000; 321: 412-419.

5. Clarke P.M., Hayes A.J., Glasziou P.G. Using the EQ-5D index score as a predictor of outcomes in patients with type 2 diabetes. Med Care. 2009 Jan; 47 (1): 61-8.

6. Clarke P., Gray A., Holman R. Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Med Decis Making. 2002 Jul-Aug; 22 (4).

7. Clarke P.M., Gray A.M., Briggs A., Farmer A.J. A model to estimate the lifetime health outcomes of patients with type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68). Diabetologia. 2004 Oct; 47 (10): 1747-59.

8. Chris G. Cameron M.Sc., Heather A. Bennett BPharm PhD. Costeffectiveness of insulin analogues for diabetes mellitus CMAJ. 2009 February 17; 180 (4).

9. Drummond M.F., Sculpher M.J., Torrance G.W. et al. Methods for the economic evaluation of health care programs. 3rd ed. Oxford (UK): Oxford University Press. 2005.

10. Garber A., Henry R., Ratner R. et al. Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet. 2009; 373: 473-81.

11. http://www.aptekarsk.ru

12. http://www.endocrincentr.ru/pacient/price/

13. IDF Diabetes Atlas 5th edition, 2012 update© International Diabetes Federation, 2012

14. Khaw K.T., Wareham N., Bingham S. et al. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European Prospective Investigation into Cancer in Norfolk. Ann. Intern. Med. 2004; 141: 413-20.

15. Law M.R, Morris J.K., Wald N.J. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665.

16. Lee W.C., Conner C., Hammer M. Cost-effectiveness of liraglutide versus rosiglitazone, both in combination with glimepiride in treatment of type 2 diabetes in the US. Curr. Med. Res. Opin. 2011 May; 27 (5): 897-906.

17. Marre M., Shaw J., Brandle M. et al. Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with type 2 diabetes (LEAD-1 SU). Diabet Med. 2009; 26: 268-78.

18. McGill J.B. Insights from the Liraglutide Clinical Development Program – the Liraglutide Effect and Action in Diabetes (LEAD) studies. Postgrad Med. 2009 May; 121 (3): 16-25.

19. Nauck M., Frid A., Hermansen K. et al. Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (Liraglutide Effect and Action in Diabetes)-2 study. Diabetes Care. 2009; 32: 84-90.

20. Patrick W. Sullivan PhD and Vahram Ghushchyan PhD. Preference-Based EQ-5D Index Scores for Chronic Conditions in the United States. Med Decis Making. 2006; 26 (4): 410-420.

21. Russell-Jones D., Vaag A., Schmitz O. et al. Liraglutide versus insulin glargine in combination with metformin and sulfonylurea therapy in type 2 diabetes: A randomized controlled trial (LEAD-5 met+SU). Diabetologia. In press.

22. Sountsov Yu.I., Dedov I.I. The State Register of Diabetec Patients – the main information system calculating and planning the state economic spending on Diabetes. Sakharny Diabet. 2005; 2.

23. Stratton I.M., Adler A.I., Neil H.A., Matthews D.R., Manley S.E., Cull C.A., Hadden D., Turner R.C., Holman R.R. Association of glycemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000; 321: 405-412.

24. Zinman B., Gerich J., Buse J.B. et al. Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD). Diabetes Care. 2009; 32: 1224-30.


For citation:


Kulikov A.Y., Novikov I.V. . PHARMACOECONOMICS. Modern pharmacoeconomics and pharmacoepidemiology. 2013;6(4):13-20.

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ISSN 2070-4909 (Print)
ISSN 2070-4933 (Online)