title: Cost-effectiveness of saxagliptin vs glimepiride as a second-line therapy added to metformin in Type 2 diabetes in China.
abstract: OBJECTIVE
  This study aims to estimate the long-term cost-effectiveness of saxagliptin + metformin (SAXA + MET) vs glimepiride + metformin (GLI + MET) in patients with Type 2 diabetes mellitus (T2DM) inadequately controlled with MET in China.
  
  
  METHODS
  The Cardiff Model was used to simulate disease progression and estimate the long-term effect of treatments on patients. Systematic literature reviews and hospital surveys were conducted to obtain patients profiles, clinical data, and costs. Health insurance costs (2014¥) were estimated over a 40-year period. One-way and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  SAXA + MET had lower predicted incidences of cardiovascular and hypoglycemia events and a decreased total cost compared with GLI + MET (¥241,072,807 vs ¥285,455,177). There were increased numbers of quality-adjusted life-years (QALYs; 1.01/patient) and life-years (Lys; 0.03/patient) gained with SAXA + MET compared with GLI + MET, and the incremental cost of SAXA + MET vs GLI + MET (-¥44,382) resulted in -¥43,883/QALY and -¥1,710,926/LY gained with SAXA + MET. Sensitivity analyses confirmed that the results were robust.
  
  
  CONCLUSIONS
  In patients with T2DM in China, SAXA + MET was more cost-effective and was well tolerated with fewer adverse effects (AEs) compared with GLI + MET. As a second-line therapy for T2DM, SAXA may address some of the unmet medical needs attributable to AEs in the treatment of T2DM.
authors.affiliation: a a Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine , Hangzhou City , Zhejiang Province , PR China.
authors.forename: Shuyan
authors.initials: S
authors.lastname: Gu
authors.affiliation: b b Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Deng
authors.affiliation: c c Department of Global Health Systems and Development , School of Public Health and Tropical Medicine, Tulane University , New Orleans, LA , USA.
authors.forename: Lizheng
authors.initials: L
authors.lastname: Shi
authors.affiliation: d d Department of Endocrinology and Metabolism , Chinese PLA General Hospital, Chinese PLA Medical College , Beijing , PR China.
authors.forename: Yiming
authors.initials: Y
authors.lastname: Mu
authors.affiliation: a a Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine , Hangzhou City , Zhejiang Province , PR China.
authors.forename: Hengjin
authors.initials: H
authors.lastname: Dong
mesh_terms: D000218:Adamantane / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000191:economics / Q000209:etiology; D002681:China; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D004151:Dipeptides / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000191:economics*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D007345:Insurance Claim Review / Q000191:economics / Q000706:statistics & numerical data; D007674:Kidney Diseases / Q000191:economics / Q000209:etiology; D008297:Male; D008687:Metformin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use
chemical_list: D004151:Dipeptides; D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; C057619:glimepiride; D008687:Metformin; C502994:saxagliptin; D000218:Adamantane
keywords: Cardiff model; China; Cost-effectiveness; Glimepiride; Saxagliptin; Sulfonylurea; Type 2 diabetes