Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec;7(4):825-845.
doi: 10.1007/s13300-016-0206-7. Epub 2016 Oct 27.

The Cost-Effectiveness of Alogliptin Versus Sulfonylurea as Add-on Therapy to Metformin in Patients with Uncontrolled Type 2 Diabetes Mellitus

Jason Gordon  1   2   3 , Phil McEwan  4   5 , Michael Hurst  4 , Jorge Puelles  6
Affiliations

The Cost-Effectiveness of Alogliptin Versus Sulfonylurea as Add-on Therapy to Metformin in Patients with Uncontrolled Type 2 Diabetes Mellitus

Jason Gordon et al. Diabetes Ther. 2016 Dec.

Abstract

Introduction: ENDURE (ClinicalTrials.gov identifier, NCT00856284), a multicenter, double-blind, active-controlled study of 2639 patients with uncontrolled type 2 diabetes mellitus (T2DM), found that metformin in combination with alogliptin (12.5 and 25 mg doses), when compared to standard add-on therapy (sulfonylurea, SU), exerted sustained antihyperglycemic effects over 2 years. This economic analysis of ENDURE aimed to quantify the relationship between increased glycemic durability and cost-effectiveness of alogliptin in the UK clinical setting, and communicate its sustained glycemic benefit in economic terms.

Methods: Using baseline characteristics and treatment effects from the ENDURE trial population, between-group cost-effectiveness analyses compared the combined use of metformin and alogliptin (MET + ALO12.5/25) in patients with inadequately controlled T2DM, as an alternative to metformin and SU (MET + SU). In scenario analyses, an intragroup cost-effectiveness analysis compared MET + ALO12.5/25 with MET + SU; a between-group cost-effectiveness analysis also compared MET + ALO12.5/25 versus MET + SU within a subpopulation of patients who achieved HbA1c control (<7.5%) at 2 years on study drug.

Results: Compared with baseline profiles of patients, combination therapies with alogliptin or SU were associated with improvements in length and quality of life and were cost-effective at established norms. Despite increased drug acquisition costs, alogliptin at 12.5 mg and 25 mg doses resulted in greater predicted lifetime quality-adjusted life year (QALY) gains with associated incremental cost-effectiveness ratios (ICERs) of £10,959/QALY and £7217/QALY compared to SU, respectively.

Conclusion: The ENDURE trial and the present cost-effectiveness analysis found that the glycemic durability of alogliptin therapy was associated with improved long-term patient outcomes, QALY gains, and ICERs that were cost-effective when evaluated against standard threshold values. Alogliptin therefore represents a cost-effective treatment alternative to SU as add-on therapy to metformin in patients with poorly managed T2DM.

Funding: Takeda Development Centre Europe Ltd.

Keywords: Alogliptin; Cost-effectiveness analysis; Glycemic durability; Second-line therapy; Sulfonylurea; Type 2 diabetes mellitus.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Relationship between sustained antihyperglycemic efficacy (HbA1c) and cost-effectiveness of alogliptin 12.5 mg and 25 mg vs SU ([adapted from [11])
Fig. 2
Fig. 2
Incremental cost-effectiveness ratio scatterplot (SU vs alogliptin 12.5 mg)
Fig. 3
Fig. 3
Incremental cost-effectiveness ratio scatterplot (SU vs alogliptin 25 mg)
See this image and copyright information in PMC

References

    1. Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of type 1 and type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med. 2012;29:855–862. doi: 10.1111/j.1464-5491.2012.03698.x. - DOI - PubMed
    1. National Institute for Health and Care Excellence. Type 2 diabetes in adults: management. NICE guidelines [NG28]. 2015. https://www.nice.org.uk/guidance/ng28. Accessed 22 Mar 2016.
    1. National Diabetes Audit. National Diabetes Audit 2011-2012. Report 1: Care processes and treatment targets. 2013. http://www.hscic.gov.uk/catalogue/PUB12421/nati-diab-audi-11-12-care-pro.... Accessed 22 Mar 2016.
    1. American Diabetes Association Standards of Medical Care in Diabetes—2016. Diabetes Care. 2016;39(S1):S1–S112. - PubMed
    1. Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS49) JAMA. 1999;281(21):2005–2012. doi: 10.1001/jama.281.21.2005. - DOI - PubMed

Associated data

LinkOut - more resources