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A cost-effectiveness analysis of pioglitazone plus metformin compared with rosiglitazone plus metformin from a third-party payer perspective in the US.
Curr Med Res Opin. 2009 Jun; 25(6):1343-53.CM

Abstract

OBJECTIVE

The long-term cost-effectiveness of using pioglitazone plus metformin (Actoplusmet dagger) compared with rosiglitazone plus metformin (Avandamet double dagger) in treating type 2 diabetes (T2DM) was assessed from a US third-party payer perspective.

RESEARCH DESIGN AND METHODS

Clinical efficacy (change in HbA(1c) and lipids) and baseline cohort parameters were extracted from a 12-month, randomized clinical trial (Derosa et al., 2006) evaluating the efficacy and tolerability of pioglitazone versus rosiglitazone, both in addition to metformin, in adult T2DM patients with insufficient glucose control (n = 96). A Markov-based model was used to project clinical and economic outcomes over 35 years, discounted at 3% per annum. Costs for complications were taken from published sources. Base-case assumptions were assessed through several sensitivity analyses.

MAIN OUTCOME MEASURES

Outcomes included incremental life-years, quality-adjusted life-years (QALYs), total direct medical costs, cumulative incidence of complications and associated costs, and incremental cost-effectiveness ratios (ICERs).

RESULTS

Compared to rosiglitazone plus metformin, pioglitazone plus metformin was projected to result in a modest improvement in 0.187 quality-adjusted life-years. Over patients' lifetimes, total direct medical costs were projected to be marginally lower with pioglitazone plus metformin (difference -$526.), largely due to reduced CVD complication costs. While costs were higher among renal, ulcer/amputation/neuropathy, and eye complications in the pioglitazone plus metformin group, the cost savings for CVD complications outweighed their economic impact. Pioglitazone plus metformin was found to be a dominant long-term treatment strategy in the US compared to rosiglitazone plus metformin. Sensitivity analyses showed findings to be robust under almost all scenarios, including short-term time horizons, 6% discounting, removal of individual lipid parameters, and modifications of patient cohort to more closely represent a US T2DM population. Pioglitazone plus metformin was no longer dominant with 0% discounting, with 25% reduction in its HbA(1c) effects, or with a 15% increase in its acquisition price.

CONCLUSIONS

Under a range of assumptions and study limitations around cohorts, clinical effects, and treatment patterns, this long-term analysis showed that pioglitazone plus metformin, when compared to rosiglitazone plus metformin, was a dominant treatment strategy within the US payer setting. Results were driven by the combination of modest differences in QALYs and modest savings in total complication costs over 35 years.

Authors+Show Affiliations

IMS Health, Falls Church, VA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19419339

Citation

St Charles, Meaghan, et al. "A Cost-effectiveness Analysis of Pioglitazone Plus Metformin Compared With Rosiglitazone Plus Metformin From a Third-party Payer Perspective in the US." Current Medical Research and Opinion, vol. 25, no. 6, 2009, pp. 1343-53.
St Charles M, Minshall ME, Pandya BJ, et al. A cost-effectiveness analysis of pioglitazone plus metformin compared with rosiglitazone plus metformin from a third-party payer perspective in the US. Curr Med Res Opin. 2009;25(6):1343-53.
St Charles, M., Minshall, M. E., Pandya, B. J., Baran, R. W., & Tunis, S. L. (2009). A cost-effectiveness analysis of pioglitazone plus metformin compared with rosiglitazone plus metformin from a third-party payer perspective in the US. Current Medical Research and Opinion, 25(6), 1343-53. https://doi.org/10.1185/03007990902870084
St Charles M, et al. A Cost-effectiveness Analysis of Pioglitazone Plus Metformin Compared With Rosiglitazone Plus Metformin From a Third-party Payer Perspective in the US. Curr Med Res Opin. 2009;25(6):1343-53. PubMed PMID: 19419339.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A cost-effectiveness analysis of pioglitazone plus metformin compared with rosiglitazone plus metformin from a third-party payer perspective in the US. AU - St Charles,Meaghan, AU - Minshall,Michael E, AU - Pandya,Bhavik J, AU - Baran,Robert W, AU - Tunis,Sandra L, PY - 2009/5/8/entrez PY - 2009/5/8/pubmed PY - 2010/6/12/medline SP - 1343 EP - 53 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 25 IS - 6 N2 - OBJECTIVE: The long-term cost-effectiveness of using pioglitazone plus metformin (Actoplusmet dagger) compared with rosiglitazone plus metformin (Avandamet double dagger) in treating type 2 diabetes (T2DM) was assessed from a US third-party payer perspective. RESEARCH DESIGN AND METHODS: Clinical efficacy (change in HbA(1c) and lipids) and baseline cohort parameters were extracted from a 12-month, randomized clinical trial (Derosa et al., 2006) evaluating the efficacy and tolerability of pioglitazone versus rosiglitazone, both in addition to metformin, in adult T2DM patients with insufficient glucose control (n = 96). A Markov-based model was used to project clinical and economic outcomes over 35 years, discounted at 3% per annum. Costs for complications were taken from published sources. Base-case assumptions were assessed through several sensitivity analyses. MAIN OUTCOME MEASURES: Outcomes included incremental life-years, quality-adjusted life-years (QALYs), total direct medical costs, cumulative incidence of complications and associated costs, and incremental cost-effectiveness ratios (ICERs). RESULTS: Compared to rosiglitazone plus metformin, pioglitazone plus metformin was projected to result in a modest improvement in 0.187 quality-adjusted life-years. Over patients' lifetimes, total direct medical costs were projected to be marginally lower with pioglitazone plus metformin (difference -$526.), largely due to reduced CVD complication costs. While costs were higher among renal, ulcer/amputation/neuropathy, and eye complications in the pioglitazone plus metformin group, the cost savings for CVD complications outweighed their economic impact. Pioglitazone plus metformin was found to be a dominant long-term treatment strategy in the US compared to rosiglitazone plus metformin. Sensitivity analyses showed findings to be robust under almost all scenarios, including short-term time horizons, 6% discounting, removal of individual lipid parameters, and modifications of patient cohort to more closely represent a US T2DM population. Pioglitazone plus metformin was no longer dominant with 0% discounting, with 25% reduction in its HbA(1c) effects, or with a 15% increase in its acquisition price. CONCLUSIONS: Under a range of assumptions and study limitations around cohorts, clinical effects, and treatment patterns, this long-term analysis showed that pioglitazone plus metformin, when compared to rosiglitazone plus metformin, was a dominant treatment strategy within the US payer setting. Results were driven by the combination of modest differences in QALYs and modest savings in total complication costs over 35 years. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/19419339/A_cost_effectiveness_analysis_of_pioglitazone_plus_metformin_compared_with_rosiglitazone_plus_metformin_from_a_third_party_payer_perspective_in_the_US_ DB - PRIME DP - Unbound Medicine ER -