Cost-effectiveness of rosiglitazone oral combination for the treatment of type 2 diabetes in Germany.
OBJECTIVE
To assess the cost-effectiveness of rosiglitazone in combination with other oral agents for the treatment of overweight and obese patients with type 2 diabetes in Germany.


METHODS
The Diabetes Decision Analysis of Cost--type 2 model was adapted for clinical practice and healthcare financing rules in Germany. The model was calibrated using Cost of Diabetes in Europe Type 2 study data and national statistics. The perspective is that of the sickness funds, and includes all hospital inpatient, ambulatory, rehabilitation, and diabetes therapy, other medications, and sickness leave. The model simulates lifetime treatment histories and associated health outcomes and costs for age and sex-matched cohorts of 1000 overweight and obese patients. The measures of effectiveness used in the analysis were life-years and quality adjusted life-years (QALYs).


RESULTS
The combination therapy of rosiglitazone with metformin or sulfonylurea produces better glycaemic control than conventional care of metformin with sulfonylurea and insulin in most patients, extends the viability of oral therapy before requiring insulin, and typically leads to lifetime cost increases across all treatment types. The improvements in glycaemic control lead to survival gains and reductions in morbidity, because of the reduced risk of developing or progressing to later stages of complications. Improvements in morbidity and mortality generate additional QALYs. Costs and health outcomes combine to yield favourable incremental cost-effectiveness ratios, which fall below international 'willingness-to-pay' thresholds in the medium term.


CONCLUSIONS
The model predicts that rosiglitazone in combination with other oral agents is a cost-effective intervention for the treatment of normal weight, overweight and obese patients with type 2 diabetes when compared with conventional care in Germany.
Shearer
Arran T
AT
York Health Economics Consortium, University of York, Heslington, UK. as57@york.ac.uk
Bagust
Adrian
A
Liebl
Andreas
A
Schoeffski
Oliver
O
Goertz
Anita
A
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics / Q000534:rehabilitation; D004359:Drug Therapy, Combination; D017850:Economics, Pharmaceutical; D005260:Female; D005858:Germany; D006442:Glycated Hemoglobin / Q000187:drug effects; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007328:Insulin / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D018803:Models, Economic; D009765:Obesity / Q000150:complications; D019057:Quality-Adjusted Life Years; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D000077154:Rosiglitazone; D045162:Thiazolidinediones