title: The cost-effectiveness of saxagliptin versus NPH insulin when used in combination with other oral antidiabetes agents in the treatment of type 2 diabetes mellitus in Poland.
abstract: BACKGROUND
  This study compared the health and economic benefits of saxagliptin versus insulin as second-line therapy with either metformin (MET) or sulfonylurea (SU) after failure of the respective monotherapies for patients with type 2 diabetes in Poland.
  
  
  METHODS
  The cost-effectiveness was assessed using a previously published diabetes model. Disease progression, utilities, and effects of changes in glycosylated hemoglobin (HbA1c), weight, and hypoglycemic events were taken from published studies, and Polish sources were used where possible.
  
  
  RESULTS
  MET + saxagliptin reduced severe hypoglycemic complications and weight versus MET + insulin, with an incremental benefit of 0.13 quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) of 27,454 Polish zloty (PLN) ($9,966 U.S.) per QALY gained. SU + saxagliptin showed an incremental benefit of 0.14 QALYs and ICER of 24,663 PLN ($8,953 U.S.) per QALY gained versus SU + insulin, with reduced incidence of symptomatic and severe hypoglycemias. Results were most sensitive to disutilities associated with weight gain, hypoglycemia, injection fear, HbA1c changes, threshold for switching treatment, and patients' age. Results were robust to various model assumptions and inputs. Using a willingness-to-pay threshold of 100,000 PLN ($36,300 U.S.) per QALY gained, the probability that saxagliptin is cost-effective in these analyses was 74% (MET) and 76% (SU).
  
  
  CONCLUSIONS
  Saxagliptin in combination with MET or SU is likely to represent a cost-effective treatment option in Polish patients with type 2 diabetes failing first-line treatment.
authors: Diabetological Unit, Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Zabrze, Poland.
authors: Wladyslaw
authors: W
authors: Grzeszczak
authors: Leszek
authors: L
authors: Czupryniak
authors: Katarzyna
authors: K
authors: Kolasa
authors: Cezary
authors: C
authors: Sciborski
authors: Isabelle Duprat
authors: ID
authors: Lomon
authors: Phil
authors: P
authors: McEwan
mesh_terms: D000218:Adamantane / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D004151:Dipeptides / Q000191:economics / Q000627:therapeutic use*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D007336:Insulin, Isophane / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D018803:Models, Economic; D011044:Poland / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D013453:Sulfonylurea Compounds / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000218:Adamantane; D004151:Dipeptides; D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007336:Insulin, Isophane; D008687:Metformin; D013453:Sulfonylurea Compounds; C502994:saxagliptin