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- Title
The place of DPP-4 inhibitors in the treatment algorithm of diabetes type 2: a systematic review of cost-effectiveness studies.
- Authors
Baptista, Alexandre; Teixeira, Inês; Romano, Sónia; Carneiro, António; Perelman, Julian; Teixeira, Inês; Romano, Sónia; Carneiro, António Vaz
- Abstract
<bold>Objective: </bold>To conduct a systematic review of cost-effectiveness, cost-utility, and cost-benefit studies of DPP-4 inhibitors for diabetes treatment versus other antidiabetics.<bold>Methods: </bold>Three investigators searched the CRD York, Tufts CEA Registry, and MEDLINE databases through 2015. We reviewed all potentially relevant titles and abstracts, and screened full-text articles, according to inclusion criteria. We established a quality score for each study based on a 35-item list.<bold>Results: </bold>A total of 295 studies were identified, of which 20 were included. The average quality score was 0.720 on a 0-1 scale. All studies were performed in high- and middle-income countries, using a 3rd-party payer perspective and randomized clinical trials to measure effectiveness. Sitagliptin, saxagliptin and vildagliptin had an ICER below 25,000 €/QALY, as second-line and as add-ons to metformin, in comparison to sulfonylureas. When compared with sitagliptin, liraglutide (GLP-1 receptor agonist) had an ICER of up to 22,724 €/QALY for the 1.2-mg dosage, and up to 32,869 €/QALY for the 1.8-mg dosage. Insulin glargine was dominant when compared with sitagliptin.<bold>Conclusions: </bold>According to the WHO threshold applied to the country and year of each study, DPP-4 inhibitors were highly cost-effective as second-line, as add-ons to metformin, in comparison with sulfonylureas. More recent therapies (GLP-1 receptor agonists and insulin glargine) were highly cost-effective in comparison to DPP-4 inhibitors. These results were obtained, however, on the basis of a limited number of studies, relying on the same few clinical trials, and financed by manufacturers. Further independent research is needed to confirm these findings.
- Subjects
DIABETES insipidus; DIABETIC acidosis; GLYCEMIC control; COST effectiveness; DIABETES; THERAPEUTIC use of protease inhibitors; PROTEASE inhibitors; ALGORITHMS; HYPOGLYCEMIC agents; TYPE 2 diabetes; SYSTEMATIC reviews; ECONOMICS
- Publication
European Journal of Health Economics, 2017, Vol 18, Issue 8, p937
- ISSN
1618-7598
- Publication type
journal article
- DOI
10.1007/s10198-016-0837-7