English, Article edition: Cost Effectiveness of Combination Therapy with Pioglitazone for Type 2 Diabetes Mellitus from a German Statutory Healthcare Perspective Kurt Neeser; Georg Lubben; Uwe Siebert; ...

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Physical Description
  • article
Language
  • English

Edition details

Title
  • Cost Effectiveness of Combination Therapy with Pioglitazone for Type 2 Diabetes Mellitus from a German Statutory Healthcare Perspective
Author
  • Kurt Neeser
  • Georg Lubben
  • Uwe Siebert
  • Wendelin Schramm
Physical Description
  • article
Notes
  • Background: Pioglitazone has been approved in Europe for oral combination therapy for type 2 diabetes mellitus. Along with other agents of the thiazolidinedione class, it has a novel intracellular mechanism of action. Clinical trials with pioglitazone have confirmed a strong product profile in terms of control of blood glucose and lipids. However, the drug acquisition cost for pioglitazone is greater than standard medications for type 2 diabetes. Long-term data regarding the cost effectiveness of pioglitazone-based combination therapy are not available. Objective: To evaluate, using a decision analysis model, the cost effectiveness of pioglitazone-based combination therapy compared with relevant alternative medications for the treatment of type 2 diabetes in Germany. Methods: This study compared the clinical effects and costs of pioglitazone 30mg added to metformin in patients who failed metformin monotherapy and pioglitazone added to a sulphonylurea in patients who failed sulphonylurea monotherapy, with the most relevant treatment alternatives. A published and validated Markov model was adapted to reflect the management of type 2 diabetes. This simulated the number of severe complications occurring and the mean life expectancy of a diabetic cohort, which was based on the overweight group of the UK Prospective Diabetes Study at year 6 of follow-up. Drug treatment costs, other costs for general management of type 2 diabetes and the costs of complications were combined to compute overall lifetime treatment costs from the perspective of the German statutory healthcare system in 2002. Results: Combination therapy with pioglitazone/​metformin was associated with a higher life expectancy (15.2 years) relative to sulphonylurea/​metformin (14.9 years) or acarbose/​metformin (14.7 years). Likewise, pioglitazone/​sulphonylurea (15.5 years) was superior to metformin/​sulphonylurea (14.9 years) and acarbose/​sulphonylurea (14.8 years). Undiscounted incremental cost-effectiveness ratios in comparison to the next best strategy were Conclusions: In this model, with its underlying assumptions and data, combination therapy with pioglitazone increased life expectancy in overweight type 2 diabetes patients at acceptable cost compared with other well established medications in Germany. These findings should be re-evaluated as soon as additional evidence becomes available from the currently ongoing long-term clinical and economic studies.
  • Acarbose, Cost-effectiveness, Metformin, Pioglitazone, Sulfonylureas, Thiazolidinediones, Type-2-diabetes-mellitus
  • RePEc:wkh:phecon:v:22:y:2004:i:5:p:321-341
Language
  • English
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