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The place of DPP-4 inhibitors in the treatment algorithm of diabetes type 2: a systematic review of cost-effectiveness studies

Author

Listed:
  • Alexandre Baptista

    (Faculdade de Medicina da Universidade de Lisboa)

  • Inês Teixeira

    (Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies Group)

  • Sónia Romano

    (Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies Group)

  • António Vaz Carneiro

    (Faculdade de Medicina da Universidade de Lisboa)

  • Julian Perelman

    (Universidade Nova de Lisboa)

Abstract

Objective To conduct a systematic review of cost-effectiveness, cost-utility, and cost-benefit studies of DPP-4 inhibitors for diabetes treatment versus other antidiabetics. Methods 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. Results 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. Conclusions 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.

Suggested Citation

  • Alexandre Baptista & Inês Teixeira & Sónia Romano & António Vaz Carneiro & Julian Perelman, 2017. "The place of DPP-4 inhibitors in the treatment algorithm of diabetes type 2: a systematic review of cost-effectiveness studies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(8), pages 937-965, November.
    • Handle: RePEc:spr:eujhec:v:18:y:2017:i:8:d:10.1007_s10198-016-0837-7
    DOI: 10.1007/s10198-016-0837-7
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    References listed on IDEAS

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    1. Jinsong Geng & Hao Yu & Yiwei Mao & Peng Zhang & Yingyao Chen, 2015. "Cost Effectiveness of Dipeptidyl Peptidase-4 Inhibitors for Type 2 Diabetes," PharmacoEconomics, Springer, vol. 33(6), pages 581-597, June.
    2. Jorge Elgart & Joaquin Caporale & Lorena Gonzalez & Eleonora Aiello & Maximiliano Waschbusch & Juan Gagliardino, 2013. "Treatment of type 2 diabetes with saxagliptin: a pharmacoeconomic evaluation in Argentina," Health Economics Review, Springer, vol. 3(1), pages 1-9, December.
    3. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
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    More about this item

    Keywords

    Diabetes; Cost-effectiveness studies; DPP-4 inhibitors; Systematic review;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health

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