Dapagliflozin: cost-effectiveness as an add-on therapy to metformin in the treatment of type 2 diabetes (T2DM) in Argentina and Chile.

ELGART JORGE; PRESTES MARIANA; GONZALEZ LORENA; ASTEAZARAN SANTIAGO; AIELLO ELEONORA; GARRIDO LECCA S; ALVAREZ A; ROBETS M; CORTES CUADRA P; GAGLIARDINO JJ

Montreal

Congreso; ISPOR 19th International Meeting; 2014

OBJECTIVES  :           To compare the cost-effectiveness of dapagliflozin versus sulfony-lurea (SU) added to metformin in people with T2DM inadequately controlled on metformin alone, in Argentina and Chile.             METHODS  :           A discrete event simulation model (Cardiff diabetes model) based on UKPDS 68 was used to simulate disease progression and to estimate the economic and health treatment consequences in people with T2DM. Epidemiologic and clinical efficacy parameters were obtained from the literature. The cost of medication was based on country level drug prices; the cost of macro- and microvascular events was based on tariffs from the social security system of Argentina and the National Health Insurance (FONASA) of Chile. Costs were expressed in US dollars ($). A 20-year time horizon and the payer?s per-spective were assumed. Costs and health outcomes were discounted at 5% and 3% in Argentina and Chile, respectively. Deterministic and probabilistic sensitivity analyses (PAS) were performed.             RESULTS  :           Comparison of dapagliflozin add-on to metformin versus SU addition to metformin showed an incremental benefit of 0.376 QALYs (95%CI: 0.368; 0.385) in Argentina and 0.422 QALYs (95%CI: 0.411; 0.432) in Chile. In both countries, the total cost of the dapagliflozin cohort was higher than that of the SU cohort (Incremental cost: Argentina: $3,400; Chile: $2,423). The calcu-lated Incremental Cost-Effectiveness Ratio (ICER) was $9,036 and $5,745 per QALY in Argentina and Chile, respectively. Using WHO?s criteria, dapagliflozin compared to the SU treatment strategy has 88% probability for Argentina and 99% for Chile of being highly cost-effective (ICER<  1 GDP per capita). The results were robust to sensitivity analysis.             CONCLUSIONS  :           Dapagliflozin in combination with metformin is a cost-effective treatment option for patients who are inadequately controlled with metformin monotherapy in Argentina and Chile.