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Costs and Outcomes Associated with Newer Medications for Glycemic Control in Type 2 Diabetes


FINDINGS:

  • Newer medications offer more options for glycemic (blood sugar) control in type 2 diabetes; however, they come at considerable costs.
  • Exenatide and sitagliptin conferred 0.09 and 0.12 additional quality-adjusted life years (QALYs) respectively, relative to glyburide as second-line therapy.
  • Using sitagliptin as a second-line treatment is associated with additional costs of $20,213 per person over their lifetime compared to a baseline strategy using glyburide as second-line therapy.
  • Using exenatide as a second-line treatment is associated with an additional cost of $23,849 per person over their lifetime compared to glyburide as second-line therapy.

BACKGROUND:
In 2007, 23.5 million Americans aged >20 years had diabetes compared to 18 million in 2002, and $116 billion in direct health care costs are attributable to diabetes annually. Large clinical trials from the United States and Europe have demonstrated that tighter glycemic control reduces the risk of diabetes-related complications in individuals with recent onset disease, and the FDA recently approved nine new products for glycemic control (new forms or combinations of existing classes, as well as new therapeutic classes). Investigators in this study conducted a cost-effectiveness analysis to better understand the value of adding either of two newer medications (exenatide and sitagliptin) as second-line therapy to glycemic control strategies, compared to an older medication (glyburide), for new-onset type 2 diabetes in persons 25 to 64 years of age (non-Veterans). Costs are presented in 2008 US dollars.

LIMITATIONS:

  • The model used in this study did not account for costs due to management of side effects or medication switches that may occur due to side effects.

NOTE/IMPLICATIONS:

  • The authors note that while these results suggest the newer glycemic medications would confer health benefits, they would be small in relationship to the costs. Therefore, demonstrated gains in quality of life and/or length of life are necessary for these agents to provide real economic value for patients and healthcare systems.

AUTHOR/FUNDING INFORMATION:
Drs. Sinha, Rajan and Pogach are part of HSR&D's Center for Knowledge Management for Chronic Complex Illness in East Orange, NJ. Dr. Pogach is also part of VA/HSR&D's Diabetes Mellitus Quality Enhancement Research Initiative.


PubMed Logo Sinha A, Rajan M, Hoerger T, and Pogach L. Costs and Consequences Associated with Newer Medications for Glycemic Control in Type 2 Diabetes. Diabetes Care January 7, 2010 [E-pub ahead of print]

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.