title: [Cost-effectiveness analysis of dapagliflozin compared to DPP4 inhibitors and other oral antidiabetic drugs in the treatment of type-2 diabetes mellitus in Spain].
abstract: OBJECTIVE
  To assess the efficiency of the combined therapy with metformin and dapagliflozin, a new oral anti-diabetic drug with an insulin-independent mechanism of action, in the treatment of type-2 diabetes mellitus (T2DM) compared to DPP4 inhibitors, sulphonylureas and thiazolidindiones, also combined with metformin.
  
  
  METHODS
  Cost-effectiveness analysis using a discrete event simulation model based on the results of the available clinical trials and considering patient's entire life as time horizon.
  
  
  METHODS
  National Health System perspective.
  
  
  METHODS
  The model simulated the natural history of 30,000 patients with T2DM for each of the options compared.
  
  
  METHODS
  Quality-adjusted life-years (QALY) and economic consequences of managing the disease and its complications. The analysis considered direct costs updated to 2013. A discount rate of 3% was applied to costs and health outcomes.
  
  
  RESULTS
  In the main analysis comparing dapagliflozin with DPP4 inhibitors, dapagliflozin resulted in a treatment option that would provide a slightly higher effectiveness (0.019 QALY) and lower overall associated costs (-€42). In the additional analyses, dapagliflozin was a cost-effective option compared with sulphonylureas and thiazolidinediones resulting in a cost per QALY gained of €3,560 and €2,007, respectively. The univariate and probabilistic sensitivity analyses confirmed the robustness of the results.
  
  
  CONCLUSIONS
  The results of the analyses performed suggested that dapagliflozin, in combination with metformin, would be a cost-effective alternative in the Spanish context for the treatment of T2DM.
authors.affiliation: Centro de Salud Las Águilas, Madrid, España.
authors.forename: Eduardo José
authors.initials: EJ
authors.lastname: Abad Paniagua
authors.affiliation: Hospital La Princesa, Madrid, España.
authors.forename: Pedro
authors.initials: P
authors.lastname: Casado Escribano
authors.affiliation: Hospital Carmen y Severo Ochoa, Cangas de Narcea, Asturias, España.
authors.forename: José María
authors.initials: JM
authors.lastname: Fernández Rodriguez
authors.affiliation: Centro de Salud de Arucas, Arucas, Gran Canaria, España.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Morales Escobar
authors.affiliation: Departamento de Economía de la Salud Bristol-Myers Squibb, Madrid, España.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Betegón Nicolás
authors.affiliation: Departamento de Economía de la Salud AstraZeneca, Madrid, España.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Sánchez-Covisa
authors.affiliation: Oblikue Consulting, Barcelona, España. Electronic address: max.brosa@oblikue.com.
authors.forename: Max
authors.initials: M
authors.lastname: Brosa
mesh_terms: D001559:Benzhydryl Compounds / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000191:economics* / Q000627:therapeutic use; D005960:Glucosides / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D017059:Models, Econometric; D013030:Spain
chemical_list: D001559:Benzhydryl Compounds; D054873:Dipeptidyl-Peptidase IV Inhibitors; D005960:Glucosides; D007004:Hypoglycemic Agents; C529054:dapagliflozin
keywords: Costes; Costs; DPP4 inhibitors; Dapagliflozin; Dapagliflozina; Diabetes; Inhibidores de DPP4; Sulfonilureas; Sulphonylureas; Thiazolidinediones; Tiazolidindionas