Coste-efectividad de exenatida en comparación con insulina glargina en pacientes con obesidad y diabetes mellitus tipo 2 en España / Cost-effectiveness of exenatide versus insulin glargine in Spanish patients with obesity and type 2 diabetes mellitus
Endocrinol. nutr. (Ed. impr.)
; 58(7): 331-340, ago.-sept. 2011. ilus, tab
Article
in Spanish
| IBECS
| ID: ibc-93166
Responsible library:
ES1.1
Localization: BNCS
RESUMEN
Antecedentes y objetivos Exenatida es un agonista del receptor de GLP-1 empleado como tratamiento adyuvante en la diabetes mellitus tipo 2 (DM2), que ha demostrado ser tan eficaz como insulina glargina (IG) reduciendo la concentración de hemoglobina glucosilada, cuando se administra en combinación con metformina o/y sulfonilureas. Exenatida se asocia a una reducción de peso y a una mayor incidencia de acontecimientos adversos de tipo gastrointestinal. El objetivo de este estudio fue evaluar el coste-efectividad de exenatida frente a IG en pacientes obesos con DM2, que no alcanzan un control glucémico adecuado, desde la perspectiva del sistema nacional de salud. Material y métodos Se utilizó un modelo farmacoeconómico que incluyó información procedente de un ensayo clínico internacional, aleatorizado y controlado, que comparaba exenatida con IG, en pacientes con un inadecuado control de la glucosa, en concreto de la subpoblación de pacientes obesos (IMC ≥ 30 k/m2), y de datos específicos del país. Resultados Exenatida se asocia con un incremento de años de vida ganados y años de vida ajustados por calidad (AVAC) (0,11 y 0,62, respectivamente), frente a IG. Los costes directos se incrementaron 9.306 en comparación con IG (47.010 frente a 37.704 ) siendo los costes farmacológicos los más importantes. Esto se tradujo en un coste-efectividad incremental de 15.068 /AVAC de exenatida frente a IG. Conclusiones En pacientes obesos con DM2, exenatida se asocia con mayores beneficios clínicos y mayores costes que IG. Considerando el umbral de disposición a pagar de 30.000 /AVAC para España, exenatida representa una opción eficiente en comparación con IG (AU)
ABSTRACT
Background and objectives:
Exenatide, a GLP-1 receptor agonist for adjuvant treatment of type2 diabetes mellitus (T2DM), has been shown to be as effective as insulin glargine (IG) for reducingglycated hemoglobin levels combined with metformin or/and sulphonylureas. Exenatide isassociated to weight reduction and a higher incidence of gastrointestinal adverse events. The objective of this study was to assess the cost-effectiveness of exenatide as comparedto IG in obese patients with T2DM not achieving an adequate blood glucose control from the perspective of the Spanish healthcare system.Methods:
Pharmacoeconomic model inputs were obtained from an obese subpopulation (BMI ≥30 k/m2) of an international, randomized, controlled clinical trial comparing exenatide with IGin poorly controlled T2DM patients, and were supplemented with country-specific data.Results:
Exenatide was associated to improvements in life-years gained and quality-adjusted life years (QALYs) by 0.11 and 0.62 respectively versus IG. Direct costs were D 9,306 higher as compared to IG (D 47,010 versus D 37,704, with increased pharmacy costs as the main driver).Exenatideís incremental cost-effectiveness ratio was D 15,068 per QALY gained versus IG.Conclusions:
Exenatide was associated to greater clinical benefits and higher costs in obeseT2DM patients as compared to IG. Considering a willingness-to-pay threshold of D 30,000 perQALY gained in the Spanish setting, exenatide represents an efficient option in comparison withIG (AU)
Search on Google
Collection:
National databases
/
Spain
Health context:
Sustainable Health Agenda for the Americas
Health problem:
Goal 4: Health financing
Database:
IBECS
Main subject:
Diabetes Mellitus, Type 2
/
Obesity
Type of study:
Controlled clinical trial
/
Health economic evaluation
Aspects:
Patient-preference
Limits:
Humans
Language:
Spanish
Journal:
Endocrinol. nutr. (Ed. impr.)
Year:
2011
Document type:
Article
Institution/Affiliation country:
Eli Lilly/España
/
Eli Lilly/Reino Unido
/
IMS Health/Suiza