Health and economic outcomes for exenatide once weekly, insulin, and pioglitazone therapies in the treatment of type 2 diabetes: a simulation analysis Full Text
Vascular Health and Risk Management,  Clinical Article

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.

Methods
  • 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.

Results
  • 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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