title: Costs and consequences associated with newer medications for glycemic control in type 2 diabetes.
abstract: OBJECTIVE
  Newer medications offer more options for glycemic control in type 2 diabetes. However, they come at considerable costs. We undertook a health economic analysis to better understand the value of adding two newer medications (exenatide and sitagliptin) as second-line therapy to glycemic control strategies for patients with new-onset diabetes.
  
  
  METHODS
  We performed a cost-effectiveness analysis for the U.S. population aged 25-64. A lifetime analytic horizon and health care system perspective were used. Costs and quality-adjusted life years (QALYs) were discounted at 3% annually, and costs are presented in 2008 U.S. dollars. We compared three glycemic control strategies: 1) glyburide as a second-line agent, 2) exenatide as a second-line agent, and 3) sitagliptin as a second-line agent. Outcome measures included QALYs gained, incremental costs, and the incremental cost-effectiveness ratio associated with each strategy.
  
  
  RESULTS
  Exenatide and sitagliptin conferred 0.09 and 0.12 additional QALYs, respectively, relative to glyburide as second-line therapy. In base case analysis, exenatide was dominated (cost more and provided fewer QALYs than the next most expensive option), and sitagliptin was associated with an incremental cost-effectiveness ratio of 169,572 dollars per QALY saved. Results were sensitive to assumptions regarding medication costs, side effect duration, and side effect-associated disutilities.
  
  
  CONCLUSIONS
  Exenatide and sitagliptin may confer substantial costs to health care systems. Demonstrated gains in quality and/or quantity of life are necessary for these agents to provide economic value to patients and health care systems.
authors.affiliation: Center for Healthcare KnowledgeManagement, Veterans Health Administration New Jersey, East Orange, New Jersey, USA. sinhaan1@umdnj.edu
authors.forename: Anushua
authors.initials: A
authors.lastname: Sinha
authors.forename: Mangala
authors.initials: M
authors.lastname: Rajan
authors.forename: Thomas
authors.initials: T
authors.lastname: Hoerger
authors.forename: Len
authors.initials: L
authors.lastname: Pogach
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics*; D000077270:Exenatide; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use*; D010455:Peptides / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D011719:Pyrazines / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D000068900:Sitagliptin Phosphate; D014230:Triazoles / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D014688:Venoms / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D010455:Peptides; D011719:Pyrazines; D014230:Triazoles; D014688:Venoms; D000077270:Exenatide; D000068900:Sitagliptin Phosphate