Cost-effectiveness of Saxagliptin treatment in three Latin American countries

ELGART J; CAPORALE J; AIELLO E; WASCHBUSCH M; JOTIMLIANSKY L; GAGLIARDINO JJ

Mexico

Congreso; 3rd LATIN AMERICA CONFERENCE; 2011

ISPOR

OBJETIVE: To evaluate the economic consequences of saxagliptin (SAXA) versus sulfonylurea (SU) administration in combination with metformin (MET) after failure of monotherapy treatment with MET, in patients with type 2 diabetes (T2DM). METHODS: A discrete event simulation model (Cardiff Long term cost-utility model) based on UKPDS 68 with a fixed time increase was used to simulate disease progression and to obtain an estimate of the treatment?s economic and health consequences in patients with DMT2 from Argentina, Chile and Peru. The clinical efficacy parameters for saxagliptin were obtained from the literature; drug acquisition costs, adverse effects (AEs) and microvascular and macrovascular complications were obtained from local studies. Costs were expressed in United States dollars (2009), with an annual 3.5% discount. The time horizon was 20 years. RESULTS: In all the countries the number of non-fatal events was lower in the SAXA+MET group than in the SULF+MET group. The model also predicted a lower number of fatal macro and microvascular events for the SAXA+MET-treated group. In Argentina and Perú the total cost of SAXA+MET cohort was higher than that of SULF+MET cohort, 14% and 3% respectively, while in Chile the total cost of SAXA+MET cohort was 3% lower than that of SULF+MET one. Treatment with SAXA+MET resulted in a higher number of QALYs (Argentina: 9,392 vs. 9,172; Chile: 9,794 vs. 9,594; Peru: 9,796 vs. 9,597) and LYGs (Argentina: 20,898 vs. 20,797; Chile: 23,068 vs. 23,019; Peru: 23,079 vs. 23,028) than treatment with SULF+MET. The additional cost per QALY was U$S6,691 for Argentina, U$S2,446 for Peru and U$S2,243 for Chile. CONCLUSIONS: Considering the GDP per capita in Argentina and Peru, our results suggest that the addition of saxagliptin instead of sulfonylureas to metformin therapy, would yield acceptable cost-effectiveness ratios in T2DM patients, being this combination cost-saving (dominant cost-effectiveness ratio) in Chile.