title: Cost-effectiveness of dipeptidyl peptidase-4 inhibitor monotherapy versus sulfonylurea monotherapy for people with type 2 diabetes and chronic kidney disease in Thailand.
abstract: OBJECTIVE
  With a high prevalence of chronic kidney disease (CKD) in type 2 diabetes (T2DM) in Thailand, the appropriate treatment for the patients has become a major concern. This study aimed to evaluate long-term cost-effective of dipeptidyl peptidase-4 (DPP-4) inhibitor monothearpy vs sulfonylurea (SFU) monotherapy in people with T2DM and CKD.
  
  
  METHODS
  A validated IMS CORE Diabetes Model was used to estimate the long-term costs and outcomes. The efficacy parameters were identified and synthesized using a systematic review and meta-analysis. Baseline characteristics and cost parameters were obtained from published studies and hospital databases in Thailand. Costs were expressed in 2014 US Dollars. Outcomes were presented as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to estimate parameter uncertainty.
  
  
  RESULTS
  From a societal perspective, treatment with DPP-4 inhibitors yielded more quality-adjusted life years (QALYs) (0.024) at a higher cost (>66,000 Thai baht (THB) or >1,829.27 USD) per person than SFU, resulting in the ICER of >2.7 million THB/QALY (>74,833.70 USD/QALY). The cost-effectiveness results were mainly driven by differences in HbA1c reduction, hypoglycemic events, and drug acquisition cost of DPP-4 inhibitors. At the ceiling ratio of 160,000 THB/QALY (4,434.59 USD/QALY), the probability that DPP-4 inhibitors are cost-effective compared to SFU was less than 10%.
  
  
  CONCLUSIONS
  Compared to SFU, DPP-4 inhibitor monotherapy is not a cost-effective treatment for people with T2DM and CKD in Thailand.
authors.affiliation: a Faculty of Pharmacy , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Unchalee
authors.initials: U
authors.lastname: Permsuwan
authors.affiliation: b Center of Pharmaceutical Outcome Research (CPOR), Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand.
authors.forename: Piyameth
authors.initials: P
authors.lastname: Dilokthornsakul
authors.affiliation: c Ottawa Hospital Research Institute, The Ottawa Hospital , Ottawa , Ontario , Canada.|d School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine , University of Ottawa , Ottawa , Ontario , Canada.|e Institute of Clinical and Evaluative Sciences , Toronto , Ontario , Canada.
authors.forename: Kednapa
authors.initials: K
authors.lastname: Thavorn
authors.affiliation: f Center of Health Outcomes Research and Therapeutic Safety (COHORTS), School of Pharmaceutical Sciences, University of Phayao , Phayao , Thailand.|g School of Pharmacy , Monash University Malaysia , Malaysia.
authors.forename: Surasak
authors.initials: S
authors.lastname: Saokaew
authors.affiliation: b Center of Pharmaceutical Outcome Research (CPOR), Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand.|g School of Pharmacy , Monash University Malaysia , Malaysia.|h School of Population Health , University of Queensland , Brisbane , Australia.|i School of Pharmacy , University of Wisconsin-Madison , Wisconsin , MA , USA.
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
mesh_terms: D000368:Aged; D015897:Comorbidity; D003362:Cost-Benefit Analysis / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000008:administration & dosage / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000191:economics*; D013785:Thailand
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D013453:Sulfonylurea Compounds
keywords: Chronic kidney disease; Cost-effective; DPP-4 inhibitor; Diabetes; Thailand