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Review
. 2016 Nov 22;11(11):e0167190.
doi: 10.1371/journal.pone.0167190. eCollection 2016.

Cost-Effectiveness of Saxagliptin versus Acarbose as Second-Line Therapy in Type 2 Diabetes in China

Shuyan Gu  1 , Yuhang Zeng  1 , Demin Yu  2 , Xiaoqian Hu  1 , Hengjin Dong  1
Affiliations
Review

Cost-Effectiveness of Saxagliptin versus Acarbose as Second-Line Therapy in Type 2 Diabetes in China

Shuyan Gu et al. PLoS One. .

Abstract

Objective: This study assessed the long-term cost-effectiveness of saxagliptin+metformin (SAXA+MET) versus acarbose+metformin (ACAR+MET) in Chinese patients with type 2 diabetes mellitus (T2DM) inadequately controlled on MET alone.

Methods: Systematic literature reviews were performed to identify studies directly comparing SAXA+MET versus ACAR+MET, and to obtain diabetes-related events costs which were modified by hospital surveys. A Cardiff Diabetes Model was used to estimate the long-term economic and health treatment consequences in patients with T2DM. Costs (2014 Chinese yuan) were calculated from the payer's perspective and estimated over a patient's lifetime.

Results: SAXA+MET predicted lower incidences of most cardiovascular events, hypoglycemia events and fatal events, and decreased total costs compared with ACAR+MET. For an individual patient, the quality-adjusted life-years (QALYs) gained with SAXA+MET was 0.48 more than ACAR+MET at a cost saving of ¥18,736, which resulted in a cost saving of ¥38,640 per QALY gained for SAXA+MET versus ACAR+MET. Results were robust across various univariate and probabilistic sensitivity analyses.

Conclusion: SAXA+MET is a cost-effective treatment alternative compared with ACAR+MET for patients with T2DM in China, with a little QALYs gain and lower costs. SAXA is an effective, well-tolerated drug with a low incidence of adverse events and ease of administration; it is anticipated to be an effective second-line therapy for T2DM treatment.

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Conflict of interest statement

This study was funded by AstraZeneca. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow diagram of literature review.
A detailed flow diagram that depicts search and selection processes.
Fig 2
Fig 2. Simulated progression of HbA1c in the treatment (saxagliptin+metformin) and control (acarbose+metformin) arms over the modeled time horizon.
Fig 3
Fig 3. Simulated progression of body weight in the treatment (saxagliptin+metformin) and control (acarbose+metformin) arms over the modeled time horizon.
Fig 4
Fig 4. Simulated progression of SBP in the treatment (saxagliptin+metformin) and control (acarbose+metformin) arms over the modeled time horizon.
Fig 5
Fig 5. Simulated progression of cholesterol in the treatment (saxagliptin+metformin) and control (acarbose+metformin) arms over the modeled time horizon.
Fig 6
Fig 6. Tornado diagram of the univariate sensitivity analysis.
Fig 7
Fig 7. Scatter plot of incremental cost-effectiveness ratios for the treatment (saxagliptin+metformin) arm versus control (acarbose+metformin) arm with a CE threshold value of ¥46,629 (GDP per capita in China in 2014).
Fig 8
Fig 8. Cost effectiveness acceptability curve for the treatment (saxagliptin+metformin) arm versus control (acarbose+metfromin) arm.
See this image and copyright information in PMC

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