title: Cost-utility analysis of liraglutide compared with sulphonylurea or sitagliptin, all as add-on to metformin monotherapy in Type 2 diabetes mellitus.
abstract: OBJECTIVE
  To investigate the cost-effectiveness of liraglutide as add-on to metformin vs. glimepiride or sitagliptin in patients with Type 2 diabetes uncontrolled with first-line metformin.
  
  
  METHODS
  Data were sourced from a clinical trial comparing liraglutide vs. glimepiride, both in combination with metformin, and a clinical trial comparing liraglutide vs. sitagliptin, both as add-on to metformin. Only the subgroup of patients in whom liraglutide was added to metformin monotherapy was included in the cost-utility analysis. The CORE Diabetes Model was used to simulate outcomes and costs with liraglutide 1.2 and 1.8 mg vs. glimepiride and vs. sitagliptin over patients' lifetimes. Treatment effects were taken directly from the trials. Costs and outcomes were discounted at 3.5% per annum and costs were accounted from a third-party payer (UK National Health System) perspective.
  
  
  RESULTS
  Treatment with liraglutide 1.2 and 1.8 mg resulted, respectively, in mean increases in quality-adjusted life expectancy of 0.32 ± 0.15 and 0.28 ± 0.14 quality-adjusted life years vs. glimepiride, and 0.19 ± 0.15 and 0.31 ± 0.15 quality-adjusted life years vs. sitagliptin, and was associated with higher costs of £ 3003 ± £ 678 and £ 4688 ± £ 639 vs. glimepiride, and £ 1842 ± £ 751 and £ 3224 ± £ 683 vs. sitagliptin, over a patient's lifetime. Both liraglutide doses were cost-effective, with incremental cost-effectiveness ratios of £ 9449 and £ 16,501 per quality-adjusted life year gained vs. glimepiride, and £ 9851 and £ 10,465 per quality-adjusted life year gained vs. sitagliptin, respectively.
  
  
  CONCLUSIONS
  Liraglutide, added to metformin monotherapy, is a cost-effective option for the treatment of Type 2 diabetes in a UK setting.
authors: Department of Cardiovascular Sciences, University of Leicester, UK. melanie.davies@uhl-tr.nhs.uk
authors: M J
authors: MJ
authors: Davies
authors: B D
authors: BD
authors: Chubb
authors: I C
authors: IC
authors: Smith
authors: W J
authors: WJ
authors: Valentine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics*; D000069450:Liraglutide; D008297:Male; D008687:Metformin / Q000008:administration & dosage* / Q000191:economics; D008875:Middle Aged; D011719:Pyrazines / Q000008:administration & dosage / Q000191:economics*; D019057:Quality-Adjusted Life Years; D000068900:Sitagliptin Phosphate; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000191:economics*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000191:economics*; D006113:United Kingdom; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D011719:Pyrazines; D013453:Sulfonylurea Compounds; D014230:Triazoles; D000069450:Liraglutide; D052216:Glucagon-Like Peptide 1; D008687:Metformin; D000068900:Sitagliptin Phosphate