title: Cost-utility of albiglutide versus insulin lispro, insulin glargine, and sitagliptin for the treatment of type 2 diabetes in the US.
abstract: Objective To compare the cost-utility of the glucagon-like peptide-1 receptor agonist albiglutide with those of insulin lispro (both in combination with insulin glargine), insulin glargine, and the dipeptidyl peptidase-4 inhibitor sitagliptin, representing treatments along the type 2 diabetes treatment continuum. Methods The Centre for Outcomes Research and Effectiveness (CORE) Diabetes Model was used for the cost-utility analysis. Data from three Phase 3 clinical trials (HARMONY 6, HARMONY 4, and HARMONY 3) evaluating albiglutide for the treatment of patients with type 2 diabetes were used for the baseline characteristics and treatment effects. Utilities and costs were derived from published sources. Results Albiglutide treatment was associated with an improvement in mean quality-adjusted life expectancy of 0.099, 0.033, and 0.101 years when compared with insulin lispro, insulin glargine, and sitagliptin, respectively. Over the 50-year time horizon, mean total costs in the albiglutide arm were $4332, $2597, and $2223 more than in the other respective treatments. These costs resulted in an incremental cost-utility ratio of $43,541, $79,166, and $22,094 per quality-adjusted life-year (QALY) gained for albiglutide vs insulin lispro, insulin glargine, and sitagliptin, respectively. At a willingness-to-pay threshold of $50,000 per QALY gained, there was a 53.0%, 41.5%, and 67.5% probability of albiglutide being cost-effective compared with the other respective treatments. Limitations This analysis was an extrapolation over a 50-year time horizon based on relatively short-term data obtained during clinical trials. It does not take into account potential differences between the respective treatments in adherence and persistence that can influence both effects and costs. Conclusions Albiglutide represents a reasonable treatment option for patients with type 2 diabetes based on its cost-utility, relative to insulin lispro, insulin glargine, and sitagliptin.
authors.affiliation: a GlaxoSmithKline, Research Triangle Park , NC , USA ;
authors.forename: David
authors.initials: D
authors.lastname: Bruhn
authors.affiliation: b GlaxoSmithKline , Uxbridge , UK ;
authors.forename: Alan A
authors.initials: AA
authors.lastname: Martin
authors.affiliation: c GlaxoSmithKline , Mississauga , ON , Canada ;
authors.forename: Ruben
authors.initials: R
authors.lastname: Tavares
authors.affiliation: d Ossian Health Economics and Communications GmbH , Basel , Switzerland.
authors.forename: Barnaby
authors.initials: B
authors.lastname: Hunt
authors.affiliation: d Ossian Health Economics and Communications GmbH , Basel , Switzerland.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Pollock
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000191:economics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000819:agonists* / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000187:drug effects; D006304:Health Status; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D000069036:Insulin Glargine / Q000191:economics / Q000627:therapeutic use; D061268:Insulin Lispro / Q000191:economics / Q000627:therapeutic use; D061385:Insulins / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D019057:Quality-Adjusted Life Years; D000068900:Sitagliptin Phosphate / Q000191:economics / Q000627:therapeutic use
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; D061268:Insulin Lispro; D061385:Insulins; D000068900:Sitagliptin Phosphate; C534611:rGLP-1 protein
keywords: Albiglutide; Cost-utility; Insulin; Type 2 diabetes