title: The cost-effectiveness of dapagliflozin versus sulfonylurea as an add-on to metformin in the treatment of Type 2 diabetes mellitus.
abstract: OBJECTIVE
  To assess the cost-effectiveness of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT-2) inhibitor, compared with a sulfonylurea, when added to metformin for treatment of UK people with Type 2 diabetes mellitus inadequately controlled on metformin alone.
  
  
  METHODS
  Clinical inputs sourced from a head-to-head randomized controlled trial (RCT) informed the Cardiff diabetes decision model. Risk equations developed from the United Kingdom Prospective Diabetes Study (UKPDS) were used in conjunction with the clinical inputs to predict disease progression and the incidence of micro- and macrovascular complications over a lifetime horizon. Cost and utility data were generated to present the incremental cost-effectiveness ratio (ICER) for both treatment arms, and sensitivity and scenario analyses were conducted to assess the impact of uncertainty on the final model results.
  
  
  RESULTS
  The dapagliflozin treatment arm was associated with a mean incremental benefit of 0.467 quality-adjusted life years (QALYs) [95% confidence interval (CI): 0.420; 0.665], with an incremental cost of £1246 (95% CI: £613; £1637). This resulted in an ICER point estimate of £2671 per QALY gained. Incremental costs were shown to be insensitive to parameter variation, with only treatment-related weight change having a significant impact on the incremental QALYs. Probabilistic sensitivity analysis determined that dapagliflozin had a 100% probability of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY.
  
  
  CONCLUSIONS
  Dapagliflozin in combination with metformin was shown to be a cost-effective treatment option compared with sulfonylurea from a UK healthcare perspective for people with Type 2 diabetes mellitus who are inadequately controlled on metformin monotherapy.
authors: Pharmerit International, Rotterdam, The Netherlands.
authors: M
authors: M
authors: Charokopou
authors: Centre for Health Economics, Swansea University, Monmouth, UK.|HEOR, Monmouth, UK.
authors: P
authors: P
authors: McEwan
authors: Bristol-Myers Squibb Pharmaceuticals, Uxbridge, UK.
authors: S
authors: S
authors: Lister
authors: AstraZeneca UK, Luton, UK.
authors: L
authors: L
authors: Callan
authors: AstraZeneca, Mölndal, Sweden.
authors: K
authors: K
authors: Bergenheim
authors: Tolley Health Economics, Buxton, UK.
authors: K
authors: K
authors: Tolley
authors: Bristol-Myers Squibb, Rueil-Malmaison, France.
authors: R
authors: R
authors: Postema
authors: AstraZeneca, Brussels, Belgium.
authors: R
authors: R
authors: Townsend
authors: Bristol-Myers Squibb, Rueil-Malmaison, France.
authors: M
authors: M
authors: Roudaut
mesh_terms: D001559:Benzhydryl Compounds / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000378:metabolism; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000191:economics; D005260:Female; D005960:Glucosides / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D006943:Hyperglycemia / Q000191:economics / Q000517:prevention & control* / Q000628:therapy; D007003:Hypoglycemia / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control* / Q000628:therapy; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D050177:Overweight / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D019057:Quality-Adjusted Life Years; D012306:Risk; D051247:Sodium-Glucose Transport Proteins / Q000037:antagonists & inhibitors* / Q000378:metabolism; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D006113:United Kingdom / Q000453:epidemiology; D015431:Weight Loss / Q000187:drug effects
chemical_list: D001559:Benzhydryl Compounds; D005960:Glucosides; D007004:Hypoglycemic Agents; D051247:Sodium-Glucose Transport Proteins; D013453:Sulfonylurea Compounds; C529054:dapagliflozin; D008687:Metformin