RESUMO
AIMS: The recent LIRA-SWITCH trial showed that switching from sitagliptin 100 mg to liraglutide 1.8 mg led to statistically significant and clinically relevant improvements in glycated haemoglobin (HbA1C) and body mass index (BMI). Based on these findings, the aim of the present study was to assess the long-term cost-effectiveness of switching from sitagliptin to liraglutide in patients with type 2 diabetes in the UK. MATERIALS AND METHODS: The IQVIA CORE Diabetes Model Version 8.5+ was used to project costs and clinical outcomes over patients' lifetimes. Baseline cohort characteristics and treatment effects were derived from the LIRA-SWITCH trial. Future costs and clinical benefits were discounted at 3.5% annually. Costs were accounted in pounds sterling (GBP) and expressed in 2016 values. One-way and probabilistic sensitivity analyses were performed. RESULTS: Model projections showed improved quality-adjusted life expectancy for patients with poorly controlled HbA1c upon switching from sitagliptin to liraglutide, compared with continuing sitagliptin treatment (9.18 vs 9.02 quality-adjusted life years [QALYs]). Treatment switching was associated with increased overall costs (GBP 24737 vs GBP 22362). Higher pharmacy costs were partially offset by reduced diabetes-related complication costs in patients who switched to liraglutide. Switching to liraglutide was associated with an incremental cost-effectiveness ratio of GBP 15423 per QALY gained vs continuing with sitagliptin treatment. CONCLUSIONS: Switching from sitagliptin 100 mg to liraglutide 1.8 mg in patients with poor glycaemic control was projected to improve clinical outcomes and is likely to be considered cost-effective in the UK setting and, therefore, a good use of limited NHS resources.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Hiperglicemia/prevenção & controle , Hipoglicemia/prevenção & controle , Hipoglicemiantes/uso terapêutico , Liraglutida/uso terapêutico , Modelos Econômicos , Fármacos Antiobesidade/efeitos adversos , Fármacos Antiobesidade/economia , Fármacos Antiobesidade/uso terapêutico , Índice de Massa Corporal , Estudos de Coortes , Análise Custo-Benefício , Complicações do Diabetes/economia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/prevenção & controle , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/metabolismo , Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Inibidores da Dipeptidil Peptidase IV/economia , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Monitoramento de Medicamentos , Resistência a Medicamentos , Receptor do Peptídeo Semelhante ao Glucagon 1/metabolismo , Custos de Cuidados de Saúde , Humanos , Hiperglicemia/economia , Hiperglicemia/terapia , Hipoglicemia/induzido quimicamente , Hipoglicemia/economia , Hipoglicemia/terapia , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/economia , Liraglutida/efeitos adversos , Liraglutida/economia , Sobrepeso/complicações , Sobrepeso/tratamento farmacológico , Sobrepeso/economia , Sobrepeso/metabolismo , Qualidade de Vida , Fatores de Risco , Fosfato de Sitagliptina/efeitos adversos , Fosfato de Sitagliptina/economia , Fosfato de Sitagliptina/uso terapêutico , Reino Unido/epidemiologia , Redução de Peso/efeitos dos fármacosRESUMO
AIM: To develop a modeling approach to compare clinical outcomes of nonacog beta pegol to a standard-acting factor IX (FIX) product. METHODS: Regression analysis linked FIX activity to bleed rates. Pharmacokinetic parameters were used to estimate FIX activity over time. The probability of bleeds was estimated for both treatment arms. A Markov model estimated the presence of target joints and annualized bleed rates (ABRs). RESULTS: Higher FIX activity showed reduced ABRs (p < 0.001). Target joints resulted in higher bleed rates (p < 0.001). When FIX activity levels and bleed risks were applied to the Markov model, ABRs for nonacog beta pegol and its comparator were 2.40 and 6.36, respectively. CONCLUSION: This model provides a starting point for assessing the added value of new FIX products.
