SAXAGLIPTIN OR SULFONYLUREA AFTER METFORMIN SECONDARY FAILURE:A COST-EFFECTIVENESS ANALYSIS IN COLOMBIA

JORGE ELGART; LORENA GONZALEZ; JOAQUIN CAPORALE; ELEONORA AIELLO; JUAN VALENCIA; JUAN J GAGLIARDINO

Congreso; 17th Annual Internatioal Meeting; 2012

OBJECTIVES: To evaluate the cost-effectiveness of saxagliptin plus metformin versus sulfonylurea plus metformin in T2DM patients, who cannot achieve glycemicgoals with metformin monotherapy, in Colombia. METHODS: Cost effectiveness analysis was performed using a discrete event simulation model with fixed time steps (Cardiff Diabetes Model). The characteristics of the patients included in this study and the efficacy profile for each treatment were obtained from the published literature. The cost of medication was obtained from SISMED and Farmaprecios, and the macro and microvascular events were based on POS tariffs, SOAT Manual and consultation with a local expert. The time horizon was 20 years and the applied discount rate on costs and benefits was 3.5%. One-way and probabilistic sensitivity analyses were performed for parameters and model assumptions. RESULTS: The group treated with saxagliptin combination had fewer fatal and nonfatal events and fewer episodes of hypoglycemia than the sulfonylurea combination population. In both treatment groups the costs are driven by drug costs and treatment costs associated with myocardial infarction. The incremental cost of saxagliptin combination therapy over 20 years was US$555.552. Treatment with saxagliptin plus metformin resulted in a greater number of quality-adjusted life years (QALYs) and life-years gained (LYG) than the sulfonylurea combination (9.758vs.9.504 and11.786 vs.11.758 respectively). The cost per QALY gained was US$2190. Cost-effectiveness results were robust to sensitivity analysis. CONCLUSIONS: Considering the GDP per capita in Colombia (US$6,348), our results suggest that the addition of with metformin monotherapy, is highly cost-effective compared with the addition of sulfonylurea.