Acarbose in addition to existing treatments in patients with type 2 diabetes: health economic analysis in a German setting.
OBJECTIVE
A recent retrospective meta-analysis of cardiovascular events from long-term studies with acarbose in type 2 diabetes showed that treatment was associated with a significant reduction in the risk of cardiovascular events, supporting the hypothesis that postprandial hyperglycemia is a risk factor for cardiovascular disease. The aim of the present study was to assess the cost-effectiveness of acarbose, given in addition to existing treatments, in type 2 diabetes patients, based on these findings, in the German setting.


METHODS
The CORE Diabetes Model, a published, validated computer simulation model, was used to project long-term clinical and cost outcomes in type 2 diabetes patients receiving acarbose or placebo in addition to existing treatments. Direct costs were retrieved from published sources and projected over patient lifetimes from a third party payer perspective. Costs and clinical benefits were discounted at 5% annually. Extensive sensitivity analyses were performed.


RESULTS
Acarbose treatment was associated with improvements in discounted life expectancy (0.21 years) and quality-adjusted life expectancy (QALE) (0.19 QALYs) but was on average marginally more expensive than treatment in the placebo arm (euro135 per patient). This led to incremental cost-effectiveness ratios of euro633 per life year and euro692 per quality-adjusted life year gained. Sensitivity analysis showed that these findings were robust under variation in a range of assumptions.


CONCLUSIONS
Addition of acarbose to existing treatment was associated with improvements in life expectancy and quality-adjusted life expectancy, and provides excellent value for money over patient lifetimes in the German setting.
Roze
Stéphane
S
CORE - Center for Outcomes Research, Binningen, Switzerland. info@thecenter.ch
Valentine
William J
WJ
Evers
Thomas
T
Palmer
Andrew J
AJ
D020909:Acarbose / Q000191:economics* / Q000627:therapeutic use*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics* / Q000628:therapy; D005858:Germany; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use*; D008017:Life Expectancy; D008875:Middle Aged
D007004:Hypoglycemic Agents; D020909:Acarbose