Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system.
OBJECTIVE
To compare costs and clinical benefits of three additional therapies to metformin (MF) for patients with diabetes mellitus type 2 (DM2).


METHODS
A discrete event simulation model was built to estimate the cost-utility ratio (cost per quality-adjusted life years [QALY]) of saxagliptine as an additional therapy to MF when compared to rosiglitazone or pioglitazone. A budget impact model (BIM) was built to simulate the economic impact of saxagliptine use in the context of the Brazilian private health system.


RESULTS
The acquiring medication costs for the hypothetical patient group analyzed in a time frame of three years, were R$ 10,850,185, R$ 14,836,265 and R$ 14,679,099 for saxagliptine, pioglitazone and rosiglitazone, respectively. Saxagliptine showed lower costs and greater effectiveness in both comparisons, with projected savings for the first three years of R$ 3,874 and R$ 3,996, respectively. The BIM estimated cumulative savings of R$ 417,958 with the repayment of saxagliptine in three years from the perspective of a health plan with 1,000,000 covered individuals.


CONCLUSIONS
From the perspective of private paying source, the projection is that adding saxagliptine with MF save costs when compared with the addition of rosiglitazone or pioglitazone in patients with DM2 that have not reached the HbA1c goal with metformin monotherapy. The BIM of including saxagliptine in the reimbursement lists of health plans indicated significant savings on the three-year horizon.
Health Economics and Outcome Research, Medical Division, Bristol-Myers Squibb, São Paulo, SP, Brazil. 　marcelo.nita@bms.com
Marcelo Eidi
ME
Nita
Freddy G
FG
Eliaschewitz
Eliane
E
Ribeiro
Elio
E
Asano
Elias
E
Barbosa
Maíra
M
Takemoto
Bonnie
B
Donato
Roberto
R
Rached
Elaine
E
Rahal
D000218:Adamantane / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D004151:Dipeptides / Q000008:administration & dosage / Q000191:economics; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D008687:Metformin / Q000008:administration & dosage / Q000191:economics; D008875:Middle Aged; D000077205:Pioglitazone; D017149:Private Sector; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000191:economics
D004151:Dipeptides; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D008687:Metformin; C502994:saxagliptin; D000218:Adamantane; D000077205:Pioglitazone