Comparing the long-term cost-effectiveness of repaglinide plus metformin versus nateglinide plus metformin in type 2 diabetes patients with inadequate glycaemic control: an application of the CORE Diabetes Model in type 2 diabetes.
OBJECTIVE
As an example application of the CORE Diabetes Model in type 2 diabetes, we simulated the cost-effectiveness of repaglinide/metformin combination therapy versus nateglinide/metformin for treatment of individuals with type 2 diabetes with an inadequate response to sulphonylurea, metformin, or fixed dose glyburide/metformin.


METHODS
The CORE Diabetes Model was used to simulate long-term outcomes for a cohort of individuals with type 2 diabetes treated with either repaglinide/metformin or nateglinide/metformin. HbA1c changes for each regimen were taken from a comparative study. At the end of the study, changes in HbA1c from baseline were -1.28% points and -0.67% points for repaglinide/metformin and nateglinide/metformin, respectively. Median final doses were 5.0 mg/day for repaglinide, 360 mg/day for nateglinide and 2000 mg/day metformin in each treatment arm. Costs were calculated as the annual costs for drugs plus costs of complications (US Medicare perspective) over a 30-year period. Life expectancy (LE) and quality-adjusted life expectancy (QALE) were calculated. Outcomes and costs were discounted at 3% annually.


RESULTS
With repaglinide/metformin, improved glycaemic control led to projected decreases in complication rates, improvement of LE and QALE by 0.15 and 0.14 years respectively, and total cost savings of 3,662 dollars/person over the 30-year period. Repaglinide/metformin had a 96% probability that the incremental costs per quality-adjusted life year gained would be 20,000 dollars or less, and a 66% probability that repaglinide/metformin would be cost-saving compared to nateglinide/metformin. Sensitivity analyses supported the validity and reliability of the results.


CONCLUSIONS
In the health economic context, repaglinide/metformin combination was dominant to nateglinide/metformin. The CORE Diabetes Model is a tool to help third-party reimbursement payers identify treatments for type 2 diabetes that are good value for money.
Palmer
Andrew J
AJ
CORE--Center for Outcomes Research, Binningen/Basel, Switzerland. ap@thecenter.ch
Roze
Stéphane
S
Lammert
Morten
M
Valentine
William J
WJ
Minshall
Michael E
ME
Nicklasson
Lars
L
Gall
Mari-Anne
MA
Spinas
Giatgen A
GA
D002219:Carbamates / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D003198:Computer Simulation; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003510:Cyclohexanes / Q000191:economics / Q000627:therapeutic use*; D020000:Decision Support Systems, Clinical; D048909:Diabetes Complications / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008687:Metformin / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D017059:Models, Econometric; D000077715:Nateglinide; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010649:Phenylalanine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use*; D010880:Piperidines / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years
D002219:Carbamates; D003510:Cyclohexanes; D006442:Glycated Hemoglobin; D008687:Metformin; D000077715:Nateglinide; D010649:Phenylalanine; D010880:Piperidines; C072379:repaglinide