Real-world cost-effectiveness: lower cost of treating patients to glycemic goal with liraglutide versus exenatide.
BACKGROUND
While the liraglutide effect and action in diabetes (LEAD-6) clinical trial compared the efficacy and safety of liraglutide once daily (LIRA) to exenatide twice daily (EXEN) in adult patients with type 2 diabetes, few studies have explored the associated per-patient costs of glycemic goal achievement of their use in a real-world clinical setting.


METHODS
This retrospective cohort study used integrated medical and pharmacy claims linked with glycated hemoglobin A1C (A1C) results from the IMS Patient-Centric Integrated Data Warehouse. Patients' ≥18 years and naïve to incretin therapies during a 6-month pre-index period, with ≥1 prescription for LIRA or EXEN between January 2010 and December 2010, were included. Patients with evidence of insulin use (pre- or post-index) were excluded. Only patients who were persistent on their index treatment during a 180-day post-index period were included. Follow-up A1C assessments were based on available laboratory data within 45 days before or after the 6-month post-index point in time. Diabetes-related pharmacy costs over the 6-month post-index period were captured and included costs for both the index drugs and concomitant diabetes medications.


RESULTS
234 LIRA and 182 EXEN patients were identified for the analysis. The adjusted predicted diabetes-related pharmacy costs per patient over the 6-month post-index period were higher for LIRA compared to EXEN ($2,002 [95% confidence interval (CI): $1,981, $2,023] vs. $1,799 [95% CI: $1,778, $1,820]; P < 0.001). However, a higher adjusted predicted percentage of patients on LIRA reached A1C < 7% goal (64.4% [95% CI: 63.5, 65.3] vs. 53.6% [95% CI: 52.6, 54.6]; P < 0.05), translating into lower average diabetes-related pharmacy costs per successfully treated patient for LIRA as compared to EXEN ($3,108 vs. $3,354; P < 0.0001).


CONCLUSIONS
Although predicted diabetes-related pharmacy costs were greater with LIRA vs. EXEN, a higher proportion of patients on LIRA achieved A1C < 7%, resulting in a lower per-patient cost of A1C goal achievement with LIRA compared to EXEN.
Health Economics and Outcomes Research, IMS Health, 1725 Duke Street, Suite 510, Alexandria, VA, 22314, USA, mdekoven@us.imshealth.com.
Mitch
M
DeKoven
Won Chan
WC
Lee
Jonathan
J
Bouchard
Marjan
M
Massoudi
Jakob
J
Langer
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000191:economics*; D016527:Drug Costs; D000077270:Exenatide; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D000069450:Liraglutide; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000191:economics* / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014688:Venoms / Q000191:economics* / Q000627:therapeutic use; D055815:Young Adult
D000077270:Exenatide; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069450:Liraglutide; D010455:Peptides; D014688:Venoms; C517652:hemoglobin A1c protein, human