A short-term cost-of-treatment model for type 2 diabetes: comparison of glipizide gastrointestinal therapeutic system, metformin, and acarbose.
OBJECTIVE
To compare, from a managed care perspective, the 3-year costs of 3 first-line monotherapy strategies in type 2 diabetes patients: glipizide gastrointestinal therapeutic system (GITS), metformin, and acarbose.


METHODS
A Markov model, with a Monte Carlo simulation, was developed to compare the costs to achieve full glycemic control (hemoglobin A1c of < or = 7%) with each first-line strategy.


METHODS
The patient population for the model was assumed to be all newly diagnosed type 2 diabetes patients eligible for monotherapy with an oral agent. Each monotherapy could be succeeded by add-on treatments. The model included the costs of routine medical care and supplies, medication, adverse events, and treatment failures.


RESULTS
Using a Monte Carlo simulation, the mean 3-year cumulative costs per patient were $4971, $5273, and $5311 for glipizide GITS, metformin, and acarbose first-line strategies, respectively. The main cost drivers were drug prices. Mean 3-year cost savings for first-line glipizide GITS were $301 over metformin and $340 over acarbose. Between 83% and 85% of all simulations showed cost savings with glipizide GITS compared with the other agents.


CONCLUSIONS
The model suggests first-line monotherapy with glipizide GITS should result in desirable short-term economic benefits for managed care. Because the model incorporates recommended glycemic goals and performed well in sensitivity analyses, it should be applicable to a variety of clinical practices and useful for economic assessments of new therapies. Results of this model should be verified prospectively in typical care settings.
Ramsdell
J W
JW
Department of Medicine, University of California, San Diego, USA.
Grossman
J A
JA
Stephens
J M
JM
Botteman
M F
MF
Arocho
R
R
D020909:Acarbose; D003663:Decision Trees; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data; D005913:Glipizide / Q000008:administration & dosage* / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics; D008329:Managed Care Programs / Q000191:economics*; D008390:Markov Chains; D008687:Metformin / Q000008:administration & dosage* / Q000191:economics; D009010:Monte Carlo Method; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D014312:Trisaccharides / Q000008:administration & dosage* / Q000191:economics; D014481:United States
D007004:Hypoglycemic Agents; D014312:Trisaccharides; D008687:Metformin; D020909:Acarbose; D005913:Glipizide