Economic model of first-line drug strategies to achieve recommended glycaemic control in newly diagnosed type 2 diabetes mellitus.
OBJECTIVE
To assess the short-term direct medical costs and effectiveness associated with achieving recommended glycaemic goals using commonly prescribed first-line oral antihyperglycaemic medications in type 2 diabetes mellitus.


METHODS
A literature-based, decision-tree model was developed to project the number of patients achieving glycosylated haemoglobin values of <7% on oral therapies and the associated costs over a 3-year timeframe. For each first-line strategy, patients could progress to combination therapy using two or more agents prior to the introduction of insulin. The overall cost of treatment included costs (2001/2002 values; US dollars) of comprehensive medical care, laboratory tests, patient education, drug therapy, home glucose monitoring and adverse events.


RESULTS
At 3 years, the overall cost of treatment for the various first-line strategies was 6,106 US dollars for glipizide gastrointestinal therapeutic system, 6,727 US dollars for metformin immediate release, 6,826 US dollars for metformin extended release, 7,141 US dollars for glibenclamide (glyburide)/metformin, 7,759 US dollars for rosiglitazone and 9,298 US dollars for repaglinide. Costs of comprehensive routine medical care ranged from approximately 1,538-2,128 US dollars in year 1 and from approximately 952-1,543 US dollars in subsequent years, for controlled and uncontrolled patients, respectively. Adverse events represented <1%, and drug therapies represented approximately 50%, of the overall cost, respectively. Substantial cost differences between the strategies were seen within the first year. Regardless of first-line therapy, patients progressed quickly to combination therapies, with effectiveness among the agents being similar.


CONCLUSIONS
Short-term costs required to provide comprehensive diabetes care and achieve glycemic goals can be substantial. The model suggests a sulphonylurea strategy may provide similar effectiveness with cost savings over other agents and should be considered when selecting an initial drug therapy in newly diagnosed patients with type 2 diabetes mellitus.
Ramsdell
Joe W
JW
Division of General Internal Medicine and Geriatrics, University of California San Diego Medical Center, San Diego, CA, USA.
Braunstein
Seth N
SN
Stephens
Jennifer M
JM
Bell
Christopher F
CF
Botteman
Marc F
MF
Devine
Scott T
ST
D002219:Carbamates / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003663:Decision Trees; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics* / Q000517:prevention & control; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D016527:Drug Costs / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005913:Glipizide / Q000191:economics / Q000627:therapeutic use; D005905:Glyburide / Q000191:economics / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000187:drug effects*; D006801:Humans; D007004:Hypoglycemic Agents / Q000145:classification / Q000191:economics* / Q000627:therapeutic use*; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data; D008390:Markov Chains; D008687:Metformin / Q000191:economics / Q000627:therapeutic use; D018803:Models, Economic; D010880:Piperidines / Q000191:economics / Q000627:therapeutic use; D000077154:Rosiglitazone; D013844:Thiazoles / Q000191:economics / Q000627:therapeutic use; D045162:Thiazolidinediones; D014481:United States
D002219:Carbamates; D005913:Glipizide; D005905:Glyburide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D010880:Piperidines; D000077154:Rosiglitazone; D013844:Thiazoles; D045162:Thiazolidinediones; C072379:repaglinide