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- Title
Cost-Effectiveness of Sulfonylureas versus Metformin as First-Line Therapy in Newly Diagnosed Type 2 Diabetes.
- Authors
Willis, Michael; Borg, Sixten; Persson, Ulf; Neslusan, Cheryl
- Abstract
Although long-term outcomes trials have demonstrated that intensive drug therapy improves Type 2 Diabetes outcomes by delaying complications, uncertainty remains regarding which therapies should be used and when. Recently the ADA and EASD issued a consensus statement recommending the use of metformin (MET) for first-line therapy, relegating sulfonylureas (long the first-line standard) to possible second-line use. The ADOPT study recently showed that first-line MET and glyburide (GLY) therapy have similar HbA1c lowering at year 1, though the subsequent upward drift is lower for MET (.14 versus .24). Whether this difference matters from a long-term economic perspective depends on whether the benefits (plus cost offsets from avoided future complications) compare favorably with differences in full therapy costs (including the treatment of side-effects). This study uses newly available comparative, long-term data (the ADOPT study) to assess whether GLY versus MET as first-fine therapy is cost-effective. A Markov simulation model was used to estimate the health benefits and direct medical care costs in 1,000 newly diagnosed patients, aged 40-75, over a time period of 25 years. The model builds on prior efforts by others in this area. Treatment consists of GLY and MET monotherapy (half and then full maximal doses) followed by combination insulin therapy. The outputs include discounted Quality-Adjusted Life-Years (QALYs) (3%), discounted costs (3%), and the incremental cost-effectiveness ratio of GLY versus MET GLY monotherapy cost roughly $2,800 more than MET monotherapy over 25 years, while the MET treatment arm accumulated 0.17 more QALYs. The MET strategy, thus, is cost-saving. These results suggest that following the ADA recommendation of first-line MET is favorable versus first-line GLY when cost-effectiveness is considered. The superior durability of metformin observed in the ADOPT study contributed to this result.
- Publication
Diabetes, 2007, Vol 56, pA318
- ISSN
0012-1797
- Publication type
Academic Journal