Cost-effectiveness of rosiglitazone combination therapy for the treatment of type 2 diabetes mellitus in the UK.

Full Abstract

INTRODUCTION:
Recent clinical trial results have demonstrated that, in patients with type 2 diabetes, second-line treatment of rosiglitazone in combination with metformin can lead to significant improvements in the control of fasting plasma glucose/ glycosylated haemoglobin A1c (HbA1c) after the failure of metformin monotherapy. Our objective was to assess the cost-effectiveness of the use of rosiglitazone in combination with metformin in overweight and obese patients with type 2 diabetes in the UK, failing to maintain glycaemic control with metformin monotherapy compared with conventional care using metformin in combination with sulfonylurea.

METHODS:
The Diabetes Decision Analysis of Cost--type 2 (DiDACT) model, an established long-term economic model of type 2 diabetes, which projects the relationship between treatment and HbA1c over extended periods, was used to determine the health outcomes and economic impact for matched age and sex cohorts of 1000 patients with type 2 diabetes. The perspective was that of the UK National Health Service and all costs were in UK pounds sterling.

RESULTS:
Treatment with rosiglitazone in combination with metformin provides better glycaemic control over the remaining lifetime of patients than metformin and sulfonylurea combination therapy. Patients treated with rosiglitazone combination therapy were predicted to have a longer life expectancy, gaining 123 and 140 additional life years per 1000 patients in the obese and overweight cohorts, respectively. Improvements in morbidity and a delay in the start of insulin therapy resulted in a projected improvement in quality of life. These effects combine with projected improved survival to yield 131 and 209 additional quality-adjusted life-years (QALYs) per 1000 patients in the obese and overweight cohorts, respectively. Discounted incremental cost-effectiveness ratios were estimated at pounds 16,700 per QALY gained for the obese cohort and pounds 11,600 per QALY gained for the overweight cohort.

CONCLUSION:
The model predicts that rosiglitazone in combination with metformin is a cost-effective treatment in the UK for both obese and overweight patients failing on metformin monotherapy, compared with conventional therapy using metformin in combination with sulfonylurea.

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Author information

Author/s: Beale, Sophie (S); Bagust, Adrian (A); Shearer, Arran T (AT); Martin, Alan (A); Hulme, Lisa (L);

Affiliation: York Health Economics Consortium, University of York, Heslington, UK. sjb29(-atsign-)york.ac.uk

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't; Review

Journal: PharmacoEconomics (Pharmacoeconomics), published in New Zealand. (Language: eng)

Reference: 2006-; vol 24 Suppl 1 (issue ) : pp 21-34

Dates: Created 2006/06/27; Completed 2006/07/20; Revised 2006/11/15;

PMID: 16800160, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Pharmacoeconomics. 2006;24(9):927-9; author reply 929-35. (PMID: 16942126)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Combined Modality Therapy
Cost-Benefit Analysis
Diabetes Complications
Diabetes Mellitus, Type 2 - drug therapy; economics
Drug Therapy, Combination
Economics, Pharmaceutical
Female
Great Britain
Hemoglobin A, Glycosylated - drug effects

Hemoglobin A, Glycosylated - drug effects
Humans
Hypoglycemic Agents - economics; therapeutic use
Male
Metformin - therapeutic use
Models, Economic
Obesity - complications; economics
Quality-Adjusted Life Years
Thiazolidinediones - economics; therapeutic use

Associated Chemicals: Hemoglobin A, Glycosylated (0) ; Hypoglycemic Agents (0) ; Thiazolidinediones (0) ; rosiglitazone (122320-73-4) ; Metformin (657-24-9)

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