title: Cost-effectiveness analysis of exenatide twice daily (BID) vs insulin glargine once daily (QD) as add-on therapy in Chinese patients with Type 2 diabetes mellitus inadequately controlled by oral therapies.
abstract: OBJECTIVE
  To estimate cost-effectiveness of exenatide twice daily (BID) vs insulin glargine once daily (QD) as add-on therapy in Chinese type 2 diabetes patients not well controlled by oral anti-diabetic (OAD) agents.
  
  
  METHODS
  The Cardiff model was populated with data synthesized from three head-to-head randomized clinical trials of up to 30 weeks in China comparing exenatide BID vs insulin glargine as add-on therapies to oral therapies in the Chinese population. The Cardiff model generated outputs including macrovascular and microvascular complications, diabetes-specific mortality, costs, and quality-adjusted life years (QALYs). Cost and QALYs were estimated with a time horizon of 40 years at a discount rate of 3% from a societal perspective.
  
  
  RESULTS
  Compared with insulin glargine plus OAD treatments, patients on exenatide BID plus OAD gained 1.88 QALYs, at an incremental cost saving of Chinese Renminbi (RMB) 114,593 (i.e., cost saving of RMB 61078/QALY). The cost-effectiveness results were robust to various sensitivity analyses including probabilistic sensitivity analysis. The variables with the most impact on incremental cost-effectiveness ratio included HbA1c level at baseline, health utilities decrement, and BMI at baseline.
  
  
  CONCLUSIONS
  Compared with insulin glargine QD, exenatide BID as add-on therapy to OAD is a cost-effective treatment in Chinese patients inadequately controlled by OAD treatments.
authors.affiliation: a a 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: b b Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine , Hangzhou , Zhejiang Province , PR China.
authors.forename: Shuyan
authors.initials: S
authors.lastname: Gu
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: Hui
authors.initials: H
authors.lastname: Shao
authors.affiliation: b b Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine , Hangzhou , Zhejiang Province , PR China.
authors.forename: Hengjin
authors.initials: H
authors.lastname: Dong
authors.affiliation: d d Department of Endocrinology , Changhai Hospital, Second Military Medical University , Shanghai , PR China.
authors.forename: Dajin
authors.initials: D
authors.lastname: Zou
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
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D000077270:Exenatide; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D000069036:Insulin Glargine / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D014688:Venoms / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000077270:Exenatide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; D010455:Peptides; D014688:Venoms
keywords: Cardiff model; Cost-effectiveness; Exenatide; Insulin glargine; Type 2 diabetes mellitus (T2DM)