Health and economic outcomes for exenatide once weekly, insulin, and pioglitazone therapies in the treatment of type 2 diabetes: a simulation analysis
Vascular Health and Risk Management, 04/25/2012
Gaebler JA et al. – This long–term simulation demonstrated that exenatide once weekly (ExQW) treatment may decrease rates of cardiovascular and some microvascular complications of type 2 diabetes (T2DM). Increased quality–adjusted life–years (QALYs), and decreased costs were also projected.
The Archimedes model was used to assess outcomes for ~25,000 virtual patients with T2DM (NHANES 1999–2006 [metformin ± sulfonylureas, age 57 years, body mass index 33 kg/m2, weight 94 kg, duration T2DM 9 years, hemoglobin A1c [A1C] 8.1%]).
The effects of three treatment strategies were modeled and compared to moderate–adherence insulin therapy: advancement to high–adherence insulin at A1C ≥ 8% (treat to target A1C < 7%) and addition of pioglitazone (PIO) or ExQW from simulation start.
ExQW effects on A1C, weight, BP, and lipids were modeled from clinical trial data.
Costs, inflated to represent 2010 $US, were derived from Medicare data, Drugstore.com, and publications.
As ExQW was investigational, the authors omitted ExQW, PIO, and insulin pharmacy costs.
By year 1, ExQW treatment decreased A1C (~1.5%), weight (~2 kg), and systolic BP (~5 mmHg).
PIO and high–adherence insulin decreased A1C by ~1%, increased weight, and did not affect systolic BP.
After 20 years, A1C was ~7% with all strategies.
ExQW decreased rates of cardiovascular and microvascular complications more than PIO or high–adherence insulin versus moderate–adherence insulin.
Over 20 years, ExQW treatment resulted in increased quality–adjusted life–years (QALYs) of ~0.3 years/person and cost savings of $469/life–year versus moderate adherence insulin.
For PIO or high–adherence insulin, QALYs were virtually unchanged, and costs/life–year versus moderate–adherence insulin increased by $69 and $87, respectively.
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