RÉSUMÉ
AIMS: To describe healthcare resource utilization (HCRU) and associated costs after initiation of injectable glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy by adult patients with type 2 diabetes (T2D) in the prospective, observational, 24-month TROPHIES study in France, Germany, and Italy. MATERIALS AND METHODS: HCRU data for cost calculations were collected by treating physicians during patient interviews at baseline and follow-up visits approximately 6, 12, 18, and 24 months after GLP-1 RA initiation with once-weekly dulaglutide or once-daily liraglutide. Costs were evaluated from the national healthcare system (third-party payer) perspective and updated to 2018 prices. RESULTS: In total, 2,005 patients were eligible for the HCRU analysis (1,014 dulaglutide; 991 liraglutide). Baseline patient characteristics were generally similar between treatment groups and countries. The largest proportions of patients using ≥2 oral glucose-lowering medications (GLMs) at baseline (42.9-43.4%) and month 24 (44.0-45.1%) and using another injectable GLM at month 24 (15.3-23.2%) were in France. Mean numbers of primary and secondary healthcare contacts during each assessment period were highest in France (range = 4.0-10.7) and Germany (range = 2.9-5.7), respectively. The greatest proportions (≥60%) of mean annualized costs per patient comprised medication costs. Mean annualized HCRU costs per patient varied by treatment cohort and country: the highest levels were in the liraglutide cohort in France (909) and the dulaglutide cohort in Germany (883). LIMITATIONS: Limitations included exclusion of patients using insulin at GLP-1 RA initiation and collection of HCRU data by physician, not via patient-completed diaries. CONCLUSIONS: Real-world HCRU and costs associated with the treatment of adults with T2D with two GLP-1 RAs in TROPHIES emphasize the need to avoid generalization with respect to HCRU and costs associated with a particular therapy when estimating the impact of a new treatment in a country-specific setting.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have become frequent treatments of hyperglycemia in type-2 diabetes (T2D). Not all types of clinical study provide information about the cost of these treatments or the effects they might have on use of other medicines and equipment to control T2D or the need for visits to a doctor or nurse and different types of treatment in hospital. This study collected this information during the regular care of adults in France, Germany, or Italy who were prescribed either dulaglutide or liraglutide (both types of GLP-1 RAs) by their family doctor or a specialist in T2D. There were differences in costs and the need for other medicines and medical services between people using either dulaglutide or liraglutide and for people who were using the same GLP-1 RA in each of the three countries. The information from this study could be used to more accurately understand the overall costs and medical care needed when patients use dulaglutide or liraglutide in France, Germany, or Italy.
Sujet(s)
Diabète de type 2 , Peptides glucagon-like , Hypoglycémiants , Fragments Fc des immunoglobulines , Liraglutide , Protéines de fusion recombinantes , Humains , Diabète de type 2/traitement médicamenteux , Diabète de type 2/économie , Liraglutide/usage thérapeutique , Liraglutide/économie , Peptides glucagon-like/analogues et dérivés , Peptides glucagon-like/usage thérapeutique , Peptides glucagon-like/économie , Peptides glucagon-like/administration et posologie , Fragments Fc des immunoglobulines/usage thérapeutique , Fragments Fc des immunoglobulines/économie , Protéines de fusion recombinantes/économie , Protéines de fusion recombinantes/usage thérapeutique , Protéines de fusion recombinantes/administration et posologie , Mâle , Hypoglycémiants/usage thérapeutique , Hypoglycémiants/économie , Femelle , Études prospectives , Adulte d'âge moyen , Sujet âgé , Ressources en santé/statistiques et données numériques , Ressources en santé/économie , Modèles économétriquesRÉSUMÉ
INTRODUCTION: Recombinant factor IX (rFIX) and recombinant FIX Fc fusion protein (rFIXFc) are standard half-life and extended half-life FIX replacement therapies, respectively, and represent established treatment options indicated for adults and children with haemophilia B. These FIX replacement therapies can be administered as prophylaxis (to prevent bleeding) or 'on-demand' (to stop bleeding). This analysis aimed to estimate the cost-effectiveness of once-weekly prophylaxis with rFIXFc versus on-demand treatment with rFIX in patients with haemophilia B without inhibitors in the Italian healthcare setting. METHODS: A Markov model was developed to assess a hypothetical cohort of adolescent or adult male patients (≥ 12 years) with haemophilia B (FIX level of ≤ 2 IU/dL) without inhibitors. Model inputs were derived from the pivotal phase 3 clinical studies for rFIXFc and rFIX, published literature and assumptions when published data were unavailable. The model employed a lifelong time horizon with 6-monthly transitions between health states, and it estimated total costs, total quality-adjusted life years (QALYs), number of bleeds, number of surgeries and incremental cost-effectiveness ratio. RESULTS: rFIXFc prophylaxis was associated with lower total costs per patient (5,308,625 versus 6,564,510) and greater total QALYs per patient (15.936 versus 11.943) compared with rFIX on-demand; rFIXFc prophylaxis was therefore the dominant treatment strategy. The model also demonstrated that rFIXFc prophylaxis was associated with fewer incremental bleeds (- 682.29) and surgeries (- 0.39) compared with rFIX on-demand. CONCLUSIONS: rFIXFc prophylaxis provides improved health outcomes and lower costs, and represents a cost-effective treatment option compared with rFIX on-demand for adolescent and adult male patients with haemophilia B. This comparative assessment of cost-effectiveness should help to inform both clinicians and healthcare policy makers when making treatment decisions for patients with haemophilia B.
Sujet(s)
Facteur IX , Hémophilie B , Fragments Fc des immunoglobulines , Protéines de fusion recombinantes , Adolescent , Adulte , Enfant , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Analyse coût-bénéfice , Facteur IX/usage thérapeutique , Facteur IX/économie , Hémophilie B/traitement médicamenteux , Hémophilie B/économie , Hémorragie/prévention et contrôle , Fragments Fc des immunoglobulines/usage thérapeutique , Fragments Fc des immunoglobulines/économie , Italie , Chaines de Markov , Années de vie ajustées sur la qualité , Protéines de fusion recombinantes/économie , Protéines de fusion recombinantes/usage thérapeutique , Protéines recombinantes/usage thérapeutique , Protéines recombinantes/économieRÉSUMÉ
OBJECTIVES: Outcomes-based contracts tie rebates and discounts for expensive drugs to outcomes. The objective was to estimate the utility of outcomes-based contracts for diabetes medications using real-world data and to identify methodologic limitations of this approach. METHODS: A population-based cohort study of adults newly prescribed a medication for diabetes with a publicly announced outcomes-based contract (ie, exenatide microspheres ["exenatide"], dulaglutide, or sitagliptin) was conducted. The comparison group included patients receiving canagliflozin or glipizide. The primary outcome was announced in the outcomes-based contract: the percentage of adults with a follow-up hemoglobin A1C <8% up to 1 year later. Secondary outcomes included the percentage of patients diagnosed with hypoglycemia and the cost of a 1-month supply. RESULTS: Thousands of adults newly filled prescriptions for exenatide (n = 5079), dulaglutide (n = 6966), sitagliptin (n = 40 752), canagliflozin (n = 16 404), or glipizide (n = 59 985). The percentage of adults subsequently achieving a hemoglobin A1C below 8% ranged from 83% (dulaglutide, sitagliptin) to 71% (canagliflozin). The rate of hypoglycemia was 25 per 1000 person-years for exenatide, 37 per 1000 person-years for dulaglutide, 28 per 1000 person-years for sitagliptin, 18 per 1000 person-years for canagliflozin, and 34 per 1000 person-years for glipizide. The cash price for a 1-month supply was $847 for exenatide, $859 for dulaglutide, $550 for sitagliptin, $608 for canagliflozin, and $14 for glipizide. CONCLUSION: Outcomes-based pricing of diabetes medications has the potential to lower the cost of medications, but using outcomes such as hemoglobin A1C may not be clinically meaningful because similar changes in A1C can be achieved with generic medications at a far lower cost.
Sujet(s)
Contrats/économie , Diabète de type 2/traitement médicamenteux , Hypoglycémiants/administration et posologie , /méthodes , Sujet âgé , Canagliflozine/administration et posologie , Canagliflozine/économie , Études de cohortes , Diabète de type 2/économie , Exénatide/administration et posologie , Exénatide/économie , Femelle , Études de suivi , Glipizide/administration et posologie , Glipizide/économie , Peptides glucagon-like/administration et posologie , Peptides glucagon-like/analogues et dérivés , Peptides glucagon-like/économie , Humains , Hypoglycémiants/économie , Fragments Fc des immunoglobulines/administration et posologie , Fragments Fc des immunoglobulines/économie , Mâle , Adulte d'âge moyen , Protéines de fusion recombinantes/administration et posologie , Protéines de fusion recombinantes/économie , Phosphate de sitagliptine/administration et posologie , Phosphate de sitagliptine/économieRÉSUMÉ
INTRODUCTION: Once-weekly semaglutide 1 mg is a novel glucagon-like peptide 1 receptor agonist (GLP-1 RA) that, in the SUSTAIN clinical trials, has demonstrated greater reductions in glycated haemoglobin (HbA1c) and body weight than the other GLP-1 RAs exenatide extended-release (ER) 2 mg, dulaglutide 1.5 mg and liraglutide 1.2 mg. The aim of this analysis was to evaluate the relative cost of control of achieving treatment goals in people with type 2 diabetes (T2D) treated with once-weekly semaglutide versus exenatide ER, dulaglutide and liraglutide from a UK perspective. METHODS: Proportions of patients reaching HbA1c targets (< 7.0% and < 7.5%), weight loss targets (≥ 5% reduction in body weight) and composite endpoints (HbA1c < 7.0% without weight gain or hypoglycaemia; reduction in HbA1c of ≥ 1% and weight loss of ≥ 5%) were obtained from the SUSTAIN clinical trials. Annual per patient treatment costs were based on wholesale acquisition costs from July 2019 in the UK. Cost of control was calculated by plotting relative treatment costs against relative efficacy. RESULTS: The annual per patient cost was similar for all GLP-1 RAs. Once-weekly semaglutide was superior to exenatide ER, dulaglutide and liraglutide in bringing patients to HbA1c and weight loss targets, and to composite endpoints. When looking at the composite endpoint of HbA1c < 7.0% without weight gain or hypoglycaemia, exenatide ER, dulaglutide and liraglutide were 50.0%, 21.6% and 51.3% less efficacious in achieving this, respectively, than once-weekly semaglutide. Consequently, the efficacy-to-cost ratios for once-weekly semaglutide were superior to all comparators in bringing patients to all endpoints. CONCLUSIONS: The present study showed that once-weekly semaglutide offers superior cost of control versus exenatide ER, dulaglutide and liraglutide in terms of achieving clinically relevant, single and composite endpoints. Once-weekly semaglutide 1 mg would therefore represent good value for money in the UK setting.
Sujet(s)
Diabète de type 2/traitement médicamenteux , Peptides glucagon-like/économie , Peptides glucagon-like/usage thérapeutique , Hypoglycémiants/économie , Hypoglycémiants/usage thérapeutique , Poids , Analyse coût-bénéfice , Calendrier d'administration des médicaments , Exénatide/économie , Exénatide/usage thérapeutique , Femelle , Peptides glucagon-like/administration et posologie , Peptides glucagon-like/analogues et dérivés , Hémoglobine glyquée/analyse , Humains , Hypoglycémie/induit chimiquement , Hypoglycémiants/administration et posologie , Fragments Fc des immunoglobulines/économie , Fragments Fc des immunoglobulines/usage thérapeutique , Liraglutide/économie , Liraglutide/usage thérapeutique , Mâle , Adulte d'âge moyen , Protéines de fusion recombinantes/économie , Protéines de fusion recombinantes/usage thérapeutique , Royaume-Uni , Prise de poidsRÉSUMÉ
BACKGROUND: The recombinant factor VIII (rFVIII)-IgG1 Fc fusion protein (rFVIII-Fc) was the first available extended half-life rFVIII, shown to prolong dosing intervals of individualised prophylaxis in patients with severe haemophilia A, maintaining low bleeding rates and unchanged or lower FVIII dose versus standard half-life (SHL) rFVIII. Few data are available about real-world experience with rFVIII-Fc, including criteria for patient switching from SHL products, follow up and prophylaxis optimisation. MATERIALS AND METHODS: A single-centre retrospective study was designed to review patients switched to rFVIII-Fc, based on individual needs, after pharmacokinetic (PK) assessment, according to routine clinical practice. In patients with adequate post-switch follow up, data about rFVIII-Fc prophylaxis were compared with those from the last 18-months SHL rFVIII prophylaxis. RESULTS: Of 25 candidates, 18 patients (15 severe, 3 moderate; aged 9-62 years; 3 with inhibitor history) started rFVIII-Fc regimens, with comparable FVIII weekly dose and reduced infusion frequency (mean -30%) in all 17 patients previously on SHL rFVIII prophylaxis thrice weekly or every other day. Over a mean 18-month follow up in 13 patients, compared with SHL products, further reduced infusion frequency (mean -40%; p<0.001; interval ≥4 days in 9 patients), improved treatment satisfaction (Hemo-sat questionnaires), significantly lower FVIII weekly dose and annual consumption (mean -12%; p=0.019), comparable bleeding rates and FVIII trough levels, and improved management of breakthrough bleeding were observed. von Willebrand Factor Antigen (VWF:Ag) correlated to PK variables and both had relationships with rFVIII-Fc weekly dose, increasing statistical significance over the follow-up period. No inhibitors or drug-related adverse events were recorded. DISCUSSION: In this real-world series of patients, a switch to rFVIII-Fc, based on careful assessment of clinical needs, PK testing and treatment monitoring, was able to optimise individual convenience, efficacy and costs of prophylaxis.
Sujet(s)
Facteur VIII , Hémophilie A , Hémorragie , Fragments Fc des immunoglobulines , Protéines de fusion recombinantes , Adolescent , Adulte , Enfant , Coûts et analyse des coûts , Facteur VIII/administration et posologie , Facteur VIII/économie , Facteur VIII/pharmacocinétique , Études de suivi , Hémophilie A/sang , Hémophilie A/traitement médicamenteux , Hémophilie A/économie , Hémorragie/sang , Hémorragie/économie , Hémorragie/prévention et contrôle , Humains , Fragments Fc des immunoglobulines/administration et posologie , Fragments Fc des immunoglobulines/économie , Mâle , Adulte d'âge moyen , Protéines de fusion recombinantes/administration et posologie , Protéines de fusion recombinantes/économie , Protéines de fusion recombinantes/pharmacocinétique , Études rétrospectivesRÉSUMÉ
Aims: To report 1-year clinical and economic outcomes from the retrospective DISPEL (Dulaglutide vs Basal InSulin in Injection Naïve Patients with Type 2 Diabetes: Effectiveness in ReaL World) Study. Materials and methods: This observational claims study included patients with type 2 diabetes (T2D) and ≥1 claim for dulaglutide or basal insulin between November 2014 and April 2017 (index date=earliest fill date). Propensity score matching was used to address treatment selection bias. Change from baseline in hemoglobin A1c (HbA1c) was compared between the matched cohorts using analysis of covariance; diabetes-related costs were analyzed using generalized linear models. Results: Matched cohorts (903 pairs total; 523 pairs with complete cost data) were balanced in baseline characteristics with mean HbA1c 8.6%, mean age 54 years. At 1 year postindex, dulaglutide patients had significantly greater reduction in HbA1c than basal insulin (-1.12% vs -0.51%, p<0.01), lower medical costs ($3753 vs $7604, p<0.01), higher pharmacy costs ($9809 vs $6175, p<0.01), and similar total costs ($13 562 vs $13 779, p=0.76). Medical and total costs per 1% HbA1c reduction were lower for dulaglutide than basal insulin (medical: $3128 vs $12 673, p<0.01; total: $11 302 vs $22 965, p<0.01), while pharmacy costs per 1% HbA1c reduction were lower without reaching statistical significance ($8174 vs $10 292, p=0.15). Conclusions: In this real-world study, patients with T2D initiating dulaglutide demonstrated greater HbA1c reduction compared with those initiating basal insulin. Although total diabetes-related costs were similar, the total diabetes-related costs per HbA1c reduction were lower for dulaglutide, highlighting the importance of evaluating effectiveness along with the economic impact of medications.
Sujet(s)
Marqueurs biologiques/analyse , Diabète de type 2/traitement médicamenteux , Diabète de type 2/économie , Peptides glucagon-like/analogues et dérivés , Coûts des soins de santé/statistiques et données numériques , Hypoglycémiants/usage thérapeutique , Fragments Fc des immunoglobulines/usage thérapeutique , Insuline/usage thérapeutique , Protéines de fusion recombinantes/usage thérapeutique , Glycémie/analyse , Diabète de type 2/anatomopathologie , Femelle , Études de suivi , Peptides glucagon-like/économie , Peptides glucagon-like/usage thérapeutique , Hémoglobine glyquée/analyse , Humains , Hypoglycémiants/économie , Fragments Fc des immunoglobulines/économie , Insuline/économie , Études longitudinales , Mâle , Adulte d'âge moyen , Pronostic , Protéines de fusion recombinantes/économie , Études rétrospectives , États-UnisRÉSUMÉ
The aim of this study was to evaluate the cost-effectiveness of Anbainuo (ABN) plus methotrexate (MTX) (ABNâ+âMTX) versus conventional disease-modifying anti-rheumatic drugs (cDMARDs) in rheumatoid arthritis (RA) patients.Forty-eight moderate to severe RA patients underwent ABNâ+âMTX or cDMARDs treatment were consecutively enrolled and assigned to ABNâ+âMTX group (nâ=â26) and control group (nâ=â22). Patients were followed up and their disease activity and quality of life (QoL) were evaluated at 3rd month, 6th month and 12th month after initiation of treatment. Treatment costs of 2 groups were calculated, then pharmacoeconomic analysis was performed.ABNâ+âMTX increased drug cost and total cost while decreased indirect cost compared with cDMARDs after 12-month treatment. ABNâ+âMTX group gained additional 0.22 quality-adjusted life years (QALY) and yielded an incremental cost-effectiveness ratio (ICER) of ¥104,293.6 per QALY after treatment. Sensitivity analysis reveals that rising ABN price by 20% produced an ICER of ¥130,403.6 per QALY, which was still lower than 3 times of the mean gross domestic product (GDP) per capita during the same period in China (¥165,960). Besides, ABNâ+âMTX was more cost-effective in severe RA patients compared to moderate RA patients.ABNâ+âMTX is cost-effective in treating moderate to severe RA patients compared with cDMARDs, although the total cost of ABNâ+âMTX is relatively higher.
Sujet(s)
Antirhumatismaux/économie , Polyarthrite rhumatoïde/traitement médicamenteux , Produits pharmaceutiques biosimilaires/économie , Coûts des médicaments/statistiques et données numériques , Fragments Fc des immunoglobulines/économie , Méthotrexate/économie , Récepteur au facteur de nécrose tumorale de type II/économie , Protéines de fusion recombinantes/économie , Sujet âgé , Antirhumatismaux/administration et posologie , Polyarthrite rhumatoïde/économie , Produits pharmaceutiques biosimilaires/administration et posologie , Analyse coût-bénéfice , Association de médicaments/économie , Femelle , Humains , Fragments Fc des immunoglobulines/administration et posologie , Mâle , Méthotrexate/administration et posologie , Adulte d'âge moyen , Années de vie ajustées sur la qualité , Récepteur au facteur de nécrose tumorale de type II/administration et posologie , Protéines de fusion recombinantes/administration et posologie , Indice de gravité de la maladie , Résultat thérapeutiqueRÉSUMÉ
Aims: This analysis evaluated the cost-effectiveness of once-weekly semaglutide vs glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes (T2D) uncontrolled on metformin or basal insulin in Sweden. Materials and methods: This cost-effectiveness analysis (CEA) was conducted using the Swedish Institute of Health Economics (IHE) Diabetes Cohort Model. Analyses were conducted from the Swedish societal perspective over a time horizon of 40 years. For patients uncontrolled on metformin, dulaglutide was the comparator, and data from the SUSTAIN 7 clinical trial was used. For patients uncontrolled on basal insulin, lixisenatide was chosen as the comparator and data was obtained from a network meta-analysis (NMA). Results: The results show that, in patients with inadequate control on metformin, semaglutide 1.0 mg dominated (i.e. provided greater clinical benefit, and was less costly) dulaglutide 1.5 mg. In patients with inadequate control on basal insulin, semaglutide 1.0 mg dominated lixisenatide. The reduction in costs is largely driven by the reduction in complications seen with once-weekly semaglutide. Limitations and conclusions: It is likely that this analysis is conservative in estimating the cardiovascular (CV) cost benefits associated with treatment with once-weekly semaglutide. In patients inadequately controlled on basal insulin, the analyses vs lixisenatide were based on results from an NMA, as no head-to-head clinical trial has been conducted for this comparison. These CEA results show that once-weekly semaglutide is a cost-effective GLP-1 RA therapy for the treatment of T2D in patients inadequately controlled on metformin or basal insulin, addressing many current clinician, patient, and payer unmet needs in Sweden.
Sujet(s)
Glycémie/effets des médicaments et des substances chimiques , Analyse coût-bénéfice , Diabète de type 2/traitement médicamenteux , Peptides glucagon-like/analogues et dérivés , Hypoglycémiants/administration et posologie , Hypoglycémiants/économie , Fragments Fc des immunoglobulines/administration et posologie , Fragments Fc des immunoglobulines/économie , Peptides/administration et posologie , Peptides/économie , Protéines de fusion recombinantes/administration et posologie , Protéines de fusion recombinantes/économie , Femelle , Financement individuel , Peptides glucagon-like/administration et posologie , Peptides glucagon-like/économie , Humains , Mâle , Adulte d'âge moyen , SuèdeRÉSUMÉ
INTRODUCTION: The SUSTAIN 3 and 7 clinical trials compared the efficacy and safety of once-weekly semaglutide relative to exenatide extended-release (ER) and dulaglutide, respectively, in the treatment of patients with type 2 diabetes (T2D). The trials included a series of clinically relevant single and composite endpoints focused on improving glycemic control and reducing body weight, while avoiding hypoglycemia. The present study combined SUSTAIN 3 and 7 outcomes with short-term treatment costs to evaluate the relative cost of control of once-weekly semaglutide versus exenatide ER and dulaglutide. METHODS: Proportions of patients reaching three endpoints were taken from SUSTAIN 3 and 7 for comparisons with exenatide ER and dulaglutide, respectively. The endpoints investigated were HbA1c < 7.0%, HbA1c < 7.0% without hypoglycemia or weight gain, and a ≥ 1.0% HbA1c reduction with ≥ 5.0% weight loss. Annual per patient treatment costs were based on US wholesale acquisition costs from July 2018. Relative cost of control was calculated by plotting the ratio of the treatment costs and the ratio of the proportions of patients reaching each endpoint on the cost-efficacy plane. RESULTS: Once-weekly semaglutide 0.5 mg and 1.0 mg were most effective at bringing patients to each of the three endpoints across both SUSTAIN trials. The efficacy-to-cost ratios for once-weekly semaglutide 0.5 mg and 1.0 mg were also superior to all comparators when assessing both the single endpoint of HbA1c < 7.0% and the two composite endpoints including weight loss and hypoglycemia. CONCLUSIONS: The present study showed that once-weekly semaglutide 0.5 mg and 1.0 mg offer superior cost of control versus exenatide ER and dulaglutide in terms of achieving single and composite endpoints, based on an analysis of retrieved dropout data. Once-weekly semaglutide 0.5 mg and 1.0 mg would therefore represent good value for money in the USA, particularly in the attainment of multi-model T2D treatment goals. FUNDING: Novo Nordisk A/S.
Sujet(s)
Diabète de type 2/traitement médicamenteux , Exénatide/usage thérapeutique , Peptides glucagon-like/analogues et dérivés , Fragments Fc des immunoglobulines/usage thérapeutique , Protéines de fusion recombinantes/usage thérapeutique , Poids , Diabète de type 2/économie , Diabète de type 2/métabolisme , Calendrier d'administration des médicaments , Exénatide/économie , Femelle , Peptides glucagon-like/économie , Peptides glucagon-like/usage thérapeutique , Hémoglobine glyquée/métabolisme , Humains , Hypoglycémiants/usage thérapeutique , Fragments Fc des immunoglobulines/économie , Mâle , Adulte d'âge moyen , Protéines de fusion recombinantes/économie , Perte de poidsRÉSUMÉ
AIM: The prevalence of Type 2 diabetes in Canada is estimated to be 7.6% and rising. Given the substantial economic burden associated with Type 2 diabetes treatment, optimizing healthcare expenditure is extremely important. In the present analysis, we evaluated the cost-effectiveness of dulaglutide 1.5 mg, a once-weekly glucagon-like peptide 1 agonist as third-line therapy relative to insulin glargine from the perspective of a Canadian healthcare payer. METHODS: A patient-level cost-utility model of Type 2 diabetes was developed to capture seven microvascular and macrovascular complications and severe and nonsevere hypoglycemia. Cohort characteristics and the relative efficacy of dulaglutide 1.5 mg and insulin glargine were derived from the AWARD-2 head-to-head trial, which was identified by systematic literature review. Cost data were derived from Canadian sources and expressed in 2016 Canadian dollars (CAD), and future cost and quality-adjusted life expectancy (QALE) estimates were discounted at 1.5% per annum. One-way and probabilistic sensitivity analyses were conducted. RESULTS: Based on the AWARD-2 trial, relative to insulin glargine, dulaglutide 1.5 mg was projected to increase QALE by 0.38 quality-adjusted life years and increase costs by CAD 19,773, resulting in an incremental cost-effectiveness ratio of CAD 52,580 per quality-adjusted life year gained. CONCLUSION: A computer simulation analysis showed that dulaglutide 1.5 mg would likely be cost-effective relative to insulin glargine in patients with Type 2 diabetes inadequately controlled on metformin and sulfonylurea in Canada.
Sujet(s)
Analyse coût-bénéfice/statistiques et données numériques , Diabète de type 2/traitement médicamenteux , Peptides glucagon-like/analogues et dérivés , Fragments Fc des immunoglobulines/économie , Fragments Fc des immunoglobulines/usage thérapeutique , Insuline glargine/économie , Insuline glargine/usage thérapeutique , Protéines de fusion recombinantes/économie , Protéines de fusion recombinantes/usage thérapeutique , Canada , Analyse coût-bénéfice/méthodes , Diabète de type 2/économie , Femelle , Peptides glucagon-like/économie , Peptides glucagon-like/usage thérapeutique , Humains , Hypoglycémiants/économie , Hypoglycémiants/usage thérapeutique , Mâle , Adulte d'âge moyen , Années de vie ajustées sur la qualitéRÉSUMÉ
AIMS: Glucagon-like peptide-1 (GLP-1) receptor agonists are appealing as glucose-lowering therapy for individuals with type 2 diabetes mellitus (T2DM) as they also reduce body weight and are associated with low rates of hypoglycaemia. This analysis assessed the long-term cost-effectiveness of semaglutide 0.5 and 1 mg vs dulaglutide 1.5 mg (two once-weekly GLP-1 receptor agonists) from a UK healthcare payer perspective, based on the head-to-head SUSTAIN 7 trial, to inform healthcare decision making. MATERIALS AND METHODS: Long-term outcomes were projected using the IQVIA CORE Diabetes Model (version 9.0). Baseline cohort characteristics, changes in physiological parameters and adverse event rates were derived from the 40-week SUSTAIN 7 trial. Costs to a healthcare payer were assessed, and these captured pharmacy costs and costs of complications. Utilities were taken from published sources. RESULTS: Once-weekly semaglutide 0.5 and 1 mg were associated with improvements in quality-adjusted life expectancy of 0.04 and 0.10 quality-adjusted life years, respectively, compared with dulaglutide 1.5 mg. Clinical benefits were achieved at reduced costs, with lifetime cost savings of GBP 35 with once-weekly semaglutide 0.5 mg and GBP 106 with the once-weekly semaglutide 1 mg, resulting from fewer diabetes-related complications due to better glycaemic control. Therefore, both doses of once-weekly semaglutide were considered dominant vs dulaglutide 1.5 mg (improving outcomes and reducing costs). CONCLUSIONS: Compared with treatment with dulaglutide, once-weekly semaglutide represents a cost-effective option for treating individuals in the UK with T2DM who are not achieving glycaemic control with metformin, projected to both improve clinical outcomes and reduce costs.
Sujet(s)
Diabète de type 2/traitement médicamenteux , Diabète de type 2/économie , Peptides glucagon-like/analogues et dérivés , Fragments Fc des immunoglobulines/administration et posologie , Protéines de fusion recombinantes/administration et posologie , Essais cliniques comme sujet/statistiques et données numériques , Analyse coût-bénéfice , Complications du diabète/économie , Complications du diabète/épidémiologie , Diabète de type 2/complications , Diabète de type 2/épidémiologie , Calendrier d'administration des médicaments , Peptides glucagon-like/administration et posologie , Peptides glucagon-like/économie , Coûts des soins de santé/statistiques et données numériques , Ressources en santé/économie , Ressources en santé/statistiques et données numériques , Humains , Fragments Fc des immunoglobulines/économie , Modèles économiques , Années de vie ajustées sur la qualité , Protéines de fusion recombinantes/économie , Facteurs temps , Royaume-Uni/épidémiologieRÉSUMÉ
Introduction: rFVIIIFC was the first extended half-life product to complete the phase 3 development program and be registered. It was developed to reduce the high treatment burden imposed by prophylaxis. It is now one of four extended half-life products available for a variety of indications in hemophilia A. This article focus on the efficacy use of rFVIIIFC in the prevention of bleeds in hemophilia A. Areas covered: This article provides an update on efficacy data from three clinical studies describing the use of rFVIIIFC in the treatment and prevention of bleeds in hemophilia A. The update includes the efficacy use of rFVIII in all age groups, in the perisurgical setting, in immune tolerance induction, and in improving the quality of life of patients. The role of rFVIIIFC prophylaxis in the face of rapidly evolving non-replacement therapy and gene therapy is summarized. Expert commentary: The role of rFVIIIFC in hemophilia A prophylaxis is uncertain in the light of development of newer prophylaxis agents with better route of administration, improved pharmacokinetic and superior efficacy profiles. While rFVIIIFC was primarily developed for prophylaxis in hemophilia A, this role may change in the face of competitive extended half-life products and non-replacement therapies.
Sujet(s)
Facteur VIII/usage thérapeutique , Hémophilie A/traitement médicamenteux , Fragments Fc des immunoglobulines/usage thérapeutique , Protéines de fusion recombinantes/usage thérapeutique , Animaux , Facteur VIII/administration et posologie , Facteur VIII/économie , Facteur VIII/pharmacologie , Hémophilie A/prévention et contrôle , Hémostase/effets des médicaments et des substances chimiques , Humains , Tolérance immunitaire/effets des médicaments et des substances chimiques , Fragments Fc des immunoglobulines/administration et posologie , Fragments Fc des immunoglobulines/économie , Fragments Fc des immunoglobulines/pharmacologie , Qualité de vie , Protéines de fusion recombinantes/administration et posologie , Protéines de fusion recombinantes/économie , Protéines de fusion recombinantes/pharmacologie , Résultat thérapeutiqueRÉSUMÉ
BACKGROUND: Congenital haemophilia A (HA) is a rare, inherited, life-long bleeding disorder characterised by prolonged or spontaneous bleeding due to the lack of clotting factor VIII (FVIII) in the body. Treatment for HA involves FVIII replacement therapy and poses great economic burden to National Health Systems and to society. Availability of novel products as extended half-life clotting factor products might change treatment approches and their economic evaluation is essential for an informed treatment choice. Accordingly the objective of the present work is to analyse the economic impact of using efmoroctocog alfa (recombinant factor VIII-Fc fusion protein, rFVIIIFc) for the treatment of children and adults with severe congenital haemophilia A (HA). METHODS: A budget impact analysis was performed to estimate the economic impact of the introduction of rFVIIIFc in the market-mix of products for the treatment of HA. The analysis condidered a 3-year time horizon and the Italian National Health System (INHS) perspective. The model estimated drug costs associated with the treatment of HA in the current scenario - representing the marketplace forecast for the time period of interest assuming that rFVIIFc is not introduced - and a new scenario, assuming that rFVIIIFc is available in the market. The size of the target population was calculated using epidemiological national data. Univariate one-way sensitivity analyses and scenario analyses were performed. RESULTS: Overall 3-year costs of treating the HA population in the current scenario were 555,277,691 Euro for the INHS. With the introduction of rFVIIIFc, the costs were reduced to 541,897,466 Euro suggesting potential savings to the INHS of 13,380,255 Euro. Results were consistent at variation of most of the model's parameters; only in case of lower dosage of conventional products and higher dosage of rFVIIIFc, costs for the INHS increased, in both cases, of about 20 million Euro. CONCLUSIONS: The use of rFVIIIFc for the treatment of HA has been recently approved by the Italian Medicines Agency (AIFA) and this is the first study estimating the financial impact of this new therapeutic alternative in the Italian context. The analysis suggests that rFVIIIFc use does not result in higher expenditure for the INHS.
Sujet(s)
Coagulants/usage thérapeutique , Facteur VIII/usage thérapeutique , Hémophilie A/thérapie , Fragments Fc des immunoglobulines/usage thérapeutique , Protéines de fusion recombinantes/usage thérapeutique , Adulte , Budgets , Enfant , Coagulants/économie , Analyse coût-bénéfice , Facteur VIII/économie , Période , Hémophilie A/économie , Hémorragie/traitement médicamenteux , Hémorragie/économie , Humains , Fragments Fc des immunoglobulines/économie , Italie , Mâle , Essais contrôlés randomisés comme sujet , Protéines de fusion recombinantes/économieRÉSUMÉ
AIMS: Dulaglutide is a new once weekly glucagon-like peptide-1 (GLP-1) receptor agonist administered via a disposable auto-injection pen for the management of type 2 diabetes mellitus (T2DM). The objective of this study was to estimate the cost-effectiveness of dulaglutide vs insulin glargine for the management of T2DM from a Japanese healthcare perspective, in accordance with recently approved Japanese Cost-Effectiveness Guidelines. METHODS: The IQVIA CORE Diabetes Model (version 9) was used to estimate the long-term costs and effects of treatment with dulaglutide and insulin glargine. Direct comparative data from the Araki 2015 trial (NCT01584232) was used to inform the analysis. Costs associated with treatment and complications were derived from Japanese sources wherever possible and inflated to 2015 Japanese Yen (JPY). Utilities were based upon a European systematic review of diabetes utilities and adjusted for use in a Japanese population. One-way and probabilistic sensitivity analyses (OWSA and PSA) were conducted on all inputs and key modeling assumptions. RESULTS: Dulaglutide 0.75 mg was associated with higher quality-adjusted life years (QALYs), life years (LYs), and total costs, compared to insulin glargine, resulting in an incremental cost-effectiveness ratio (ICER) of 416,280 JPY/QALY gained. Treatment with dulaglutide increased the time alive and free from diabetes-related complications by 4 months. OWSA and PSA indicated that results were robust to plausible variations in input parameters and modeling assumptions. LIMITATIONS: Key limitations of this study are similar to other cost-utility analyses of diabetes, including the extrapolation of short-term clinical trial data into lifelong durations. In addition, due to the lack of robust published Japanese data, some values were derived from non-Japanese sources. CONCLUSIONS: This analysis suggests that dulaglutide 0.75 mg may be a cost-effective treatment alternative to insulin glargine for patients with T2DM in Japan.
Sujet(s)
Diabète de type 2/traitement médicamenteux , Peptides glucagon-like/analogues et dérivés , Hypoglycémiants/usage thérapeutique , Fragments Fc des immunoglobulines/usage thérapeutique , Insuline glargine/usage thérapeutique , Protéines de fusion recombinantes/usage thérapeutique , Adulte , Sujet âgé , Indice de masse corporelle , Analyse coût-bénéfice , Complications du diabète/économie , Complications du diabète/prévention et contrôle , Évolution de la maladie , Femelle , Peptides glucagon-like/effets indésirables , Peptides glucagon-like/économie , Peptides glucagon-like/usage thérapeutique , Hémoglobine glyquée/effets des médicaments et des substances chimiques , Comportement en matière de santé , Dépenses de santé/statistiques et données numériques , Humains , Hypoglycémiants/économie , Fragments Fc des immunoglobulines/effets indésirables , Fragments Fc des immunoglobulines/économie , Insuline glargine/effets indésirables , Insuline glargine/économie , Japon , Espérance de vie , Lipides/sang , Mâle , Adulte d'âge moyen , Modèles économétriques , Qualité de vie , Années de vie ajustées sur la qualité , Protéines de fusion recombinantes/effets indésirables , Protéines de fusion recombinantes/économieRÉSUMÉ
BACKGROUND: Hemophilia B requires replacement therapy with factor IX (FIX) coagulation products to treat and prevent bleeding episodes. A recently introduced extended half-life (EHL) recombinant FIX replacement product provided the opportunity to compare the amount of dispensed factor and expenditures for EHL treatment compared with a standard half-life (SHL) product. OBJECTIVE: To determine factor international units (IUs) dispensed and expenditures associated with switching from nonacog alfa, the most commonly used SHL replacement product, to eftrenonacog alfa, an EHL FIX replacement product. METHODS: Two U.S. claims databases were analyzed. A large national specialty pharmacy dispensation claims database was used to identify the number of IUs dispensed and monthly charges for all patients with hemophilia B from April 2015 to June 2016. Truven Health MarketScan Research Databases (January 2010-July 2016) were used to identify IUs and expenditures for patients with claims data for at least 3 months before and after switching from the SHL to the EHL product. Medians for IUs and expenditures are presented to accommodate for skewness of data distribution. RESULTS: The national specialty pharmacy database analysis included 296 patients with moderate or severe hemophilia B (233 on SHL; 94 on EHL). Median monthly factor dispensed was 11% lower (2,142 IU) in the EHL versus SHL cohort over the study period, while individual monthly reductions ranged from 32% to 47% (9,838 IU to 16,514 IU). Using the wholesale acquisition cost, the median per-patient monthly factor expenditures over the 15-month study period were 94% higher ($23,005) for the EHL than for the SHL product. Individual median monthly expenditure differences ranged from 15% ($6,562) to 49% ($19,624). In the Truven database, 14 patients switched from the SHL to the EHL product. The amount of factor dispensed was variable; in the 1-year period before and after the switch from the SHL to the EHL product, mean IUs dispensed decreased by 3,005 IU, while median IUs dispensed increased by 4,775 IU. Factor replacement expenditures were higher after switching from the SHL to the EHL product in each of the 3-month periods examined before versus after the switch. CONCLUSIONS: This analysis of real-world data showed that switching from the SHL to the EHL product was associated with higher expenditures. Increased expenditures noted in the first 3 months after switching may be related to initial stocking up of the EHL product, but expenditures were sustained throughout the 1-year period of data analysis. Further analysis of these findings with larger numbers of patients should be explored. DISCLOSURES: This study was sponsored by Pfizer. Pfizer employees were involved in the study design; the collection, analysis, and interpretation of data; the review of the manuscript; and the decision to submit for publication. All authors are employees of Pfizer. No author received an honorarium or other form of payment related to the development of this manuscript. All authors participated in the study design, data interpretation, and manuscript review and revisions and granted approval for the submission of the manuscript. Alvir, McDonald, and Tortella also participated in data analysis. Data from this paper were presented in part at the European Association for Haemophilia and Allied Disorders Annual Meeting, February 1-3, 2017, Paris, France; at the International Society for Pharmacoeconomics and Outcomes Research Annual Meeting, May 20-24, 2017, Boston, MA; and at the International Society on Thrombosis and Haemostasis Congress, July 8-13, 2017, Berlin, Germany.
Sujet(s)
Facteurs de la coagulation sanguine/économie , Substitution de médicament/économie , Facteur IX/économie , Dépenses de santé/statistiques et données numériques , Hémophilie B/traitement médicamenteux , Fragments Fc des immunoglobulines/économie , Protéines de fusion recombinantes/économie , Données administratives des demandes de remboursement des soins de santé/statistiques et données numériques , Adolescent , Adulte , Facteurs de la coagulation sanguine/pharmacologie , Facteurs de la coagulation sanguine/usage thérapeutique , Enfant , Enfant d'âge préscolaire , Facteur IX/pharmacologie , Facteur IX/usage thérapeutique , Période , Hémophilie B/économie , Humains , Fragments Fc des immunoglobulines/pharmacologie , Fragments Fc des immunoglobulines/usage thérapeutique , Mâle , Adulte d'âge moyen , Protéines de fusion recombinantes/pharmacologie , Protéines de fusion recombinantes/usage thérapeutique , Études rétrospectives , Jeune adulteRÉSUMÉ
AIMS: Prophylaxis with recombinant factor VIII (rFVIII) is the standard of care for severe hemophilia A in Sweden. The need for frequent injections with existing rFVIII products may, however, result in poor adherence to prophylaxis, leading to increased bleeding and long-term joint damage. Recombinant FVIIIFc (rFVIIIFc) is an extended half-life fusion protein which can offer prolonged protection and reduced dosing frequency. The objective of this study was to evaluate the cost-utility of prophylaxis with rFVIIIFc in severe hemophilia A from the perspective of the Swedish health system. METHODS: A Markov model was built to estimate lifetime costs and benefits of prophylaxis with rFVIIIFc vs rFVIII products. Clinical outcomes were represented by annualized bleeding rate (ABR) and quality of life via disutility applied to bleeding events and injection frequency. Costs included the cost of FVIII for routine prophylaxis and bleed resolution. The pooled comparator was costed by weighting the cost of individual products by their market share. RESULTS: In the base case, rFVIIIFc was dominant vs the pooled comparator. Savings of SEK 9.0 million per patient resulted from lower factor consumption for prophylaxis and bleed resolution. Fewer bleeds and reduced injection frequency yielded an estimated 0.59 quality-adjusted life years (QALYs). Results were sensitive to drug dosage and robust to variation in other parameters. Probabilistic sensitivity analysis suggested a greater than 85% probability of rFVIIIFc being cost-effective at a willingness-to-pay threshold of 500,000 SEK/QALY. LIMITATIONS: Due to unavailibilty of patient-level data, treatment benefit was based on a non-adjusted indirect comparison. Dosing and treatment outcomes were assumed to persist over the model duration in the absence of long-term outcome data. CONCLUSION: The results suggest that rFVIIIFc may be a cost-effective option for hemophilia A prophylaxis, generating greater quality of life and reduced costs for the Swedish payer compared to more frequently administered rFVIII alternatives.
Sujet(s)
Facteur VIII/économie , Facteur VIII/usage thérapeutique , Hémophilie A/traitement médicamenteux , Fragments Fc des immunoglobulines/économie , Fragments Fc des immunoglobulines/usage thérapeutique , Protéines de fusion recombinantes/économie , Protéines de fusion recombinantes/usage thérapeutique , Adolescent , Adulte , Sujet âgé , Analyse coût-bénéfice , Relation dose-effet des médicaments , Période , Hémophilie A/mortalité , Hémorragie/économie , Hémorragie/prévention et contrôle , Humains , Mâle , Chaines de Markov , Adulte d'âge moyen , Modèles économétriques , Qualité de vie , Années de vie ajustées sur la qualité , Suède , Jeune adulteRÉSUMÉ
BACKGROUND: Hemophilia A is a factor VIII deficiency, associated with spontaneous, recurrent bleeding episodes. This may lead to comorbidities such as arthropathy and joint replacement, which contribute to morbidity and increased health care expenditure. Recombinant factor VIII Fc fusion protein (rFVIIIFc), a prolonged half-life factor therapy, requires fewer infusions, resulting in reduced treatment burden. OBJECTIVE: Use a budget impact analysis to assess the potential economic impact of introducing rFVIIIFc to a formulary from the perspective of a private payer in the United States. METHODS: The budget impact model was developed to estimate the potential economic impact of adding rFVIIIFc to a private payer formulary across a 2-year time period. The eligible patient population consisted of inhibitor-free adults with severe hemophilia A, receiving recombinant-based episodic or prophylaxis treatment regimens. Patients were assumed to switch from conventional recombinant factor treatment to rFVIIIFc. Only medication costs were included in the model. RESULTS: The introduction of rFVIIIFc is estimated to have a budget impact of 1.4% ($0.12 per member per month) across 2 years for a private payer population of 1,000,000 (estimated 19.7 individuals receiving treatment for hemophilia A). The introduction of rFVIIIFc is estimated to prevent 124 bleeds across 2 years at a cost of $1891 per bleed avoided. CONCLUSIONS: Hemophilia A is a rare disease with a low prevalence; therefore, the overall cost to society of introducing rFVIIIFc is small. Considerations for comprehensively assessing the budget impact of introducing rFVIIIFc should include episodic and prophylaxis regimens, bleed avoidance, and annual factor consumption required under alternative scenarios.
Sujet(s)
Facteur VIII/économie , Facteur VIII/pharmacocinétique , Frais pharmaceutiques/statistiques et données numériques , Hémophilie A/thérapie , Fragments Fc des immunoglobulines/économie , Compagnies d'assurance/économie , Protéines de fusion recombinantes/économie , Protéines de fusion recombinantes/pharmacocinétique , Adulte , Budgets/statistiques et données numériques , Facteur VIII/usage thérapeutique , Période , Hémophilie A/économie , Hémorragie/prévention et contrôle , Humains , Fragments Fc des immunoglobulines/usage thérapeutique , Mâle , Modèles économétriques , Protéines de fusion recombinantes/usage thérapeutiqueRÉSUMÉ
OBJECTIVE: Dulaglutide 1.5 mg once weekly is a novel glucagon-like peptide 1 (GLP-1) receptor agonist, for the treatment of type two diabetes mellitus (T2DM). The objective was to estimate the cost-effectiveness of dulaglutide once weekly vs liraglutide 1.8 mg once daily for the treatment of T2DM in Spain in patients with a BMI ≥30 kg/m2. METHODS: The IMS CORE Diabetes Model (CDM) was used to estimate costs and outcomes from the perspective of Spanish National Health System, capturing relevant direct medical costs over a lifetime time horizon. Comparative safety and efficacy data were derived from direct comparison of dulaglutide 1.5 mg vs liraglutide 1.8 mg from the AWARD-6 trial in patients with a body mass index (BMI) ≥30 kg/m2. All patients were assumed to remain on treatment for 2 years before switching treatment to basal insulin at a daily dose of 40 IU. One-way sensitivity analyses (OWSA) and probabilistic sensitivity analyses (PSA) were conducted to explore the sensitivity of the model to plausible variations in key parameters and uncertainty of model inputs. RESULTS: Under base case assumptions, dulaglutide 1.5 mg was less costly and more effective vs liraglutide 1.8 mg (total lifetime costs 108,489 vs 109,653; total QALYS 10.281 vs 10.259). OWSA demonstrated that dulaglutide 1.5 mg remained dominant given plausible variations in key input parameters. Results of the PSA were consistent with base case results. LIMITATIONS: Primary limitations of the analysis are common to other cost-effectiveness analyses of chronic diseases like T2DM and include the extrapolation of short-term clinical data to the lifetime time horizon and uncertainty around optimum treatment durations. CONCLUSION: The model found that dulaglutide 1.5 mg was more effective and less costly than liraglutide 1.8 mg for the treatment of T2DM in Spain. Findings were robust to plausible variations in inputs. Based on these results, dulaglutide may result in cost savings to the Spanish National Health System.
Sujet(s)
Diabète de type 2/traitement médicamenteux , Peptides glucagon-like/analogues et dérivés , Hypoglycémiants/économie , Fragments Fc des immunoglobulines/économie , Liraglutide/économie , Protéines de fusion recombinantes/économie , Sujet âgé , Indice de masse corporelle , Simulation numérique , Analyse coût-bénéfice , Complications du diabète/économie , Complications du diabète/prévention et contrôle , Calendrier d'administration des médicaments , Frais pharmaceutiques/statistiques et données numériques , Femelle , Glucagon-like peptide 1/antagonistes et inhibiteurs , Peptides glucagon-like/économie , Peptides glucagon-like/usage thérapeutique , Hémoglobine glyquée/effets des médicaments et des substances chimiques , Services de santé/économie , Services de santé/statistiques et données numériques , Humains , Hypoglycémiants/usage thérapeutique , Fragments Fc des immunoglobulines/usage thérapeutique , Liraglutide/usage thérapeutique , Mâle , Chaines de Markov , Adulte d'âge moyen , Modèles économétriques , Années de vie ajustées sur la qualité , Protéines de fusion recombinantes/usage thérapeutique , EspagneRÉSUMÉ
OBJECTIVE: To assess the cost-effectiveness of exenatide 2 mg once-weekly (EQW) compared to dulaglutide 1.5 mg QW, liraglutide 1.2 mg and 1.8 mg once-daily (QD), and lixisenatide 20 µg QD for the treatment of adult patients with type 2 diabetes mellitus (T2DM) not adequately controlled on metformin. METHODS: The Cardiff Diabetes Model was applied to evaluate cost-effectiveness, with treatment effects sourced from a network meta-analysis. Quality-adjusted life years (QALYs) were calculated with health-state utilities applied to T2DM-related complications, weight changes, hypoglycemia, and nausea. Costs (GBP £) included drug treatment, T2DM-related complications, severe hypoglycemia, nausea, and treatment discontinuation due to adverse events. A 40-year time horizon was used. RESULTS: In all base-case comparisons, EQW was associated with a QALY gain per patient; 0.046 vs dulaglutide 1.5 mg; 0.102 vs liraglutide 1.2 mg; 0.043 vs liraglutide 1.8 mg; and 0.074 vs lixisenatide 20 µg. Cost per patient was lower for EQW than for liraglutide 1.8 mg (-£2,085); therefore, EQW dominated liraglutide 1.8 mg. The cost difference per patient between EQW and dulaglutide 1.5 mg, EQW and liraglutide 1.2 mg, and EQW and lixisenatide 20 µg was £27, £103, and £738, respectively. Cost per QALY gained with EQW vs dulaglutide 1.5 mg, EQW vs liraglutide 1.2 mg, and EQW vs lixisenatide 20 µg was £596, £1,004, and £10,002, respectively. In the probabilistic sensitivity analysis, the probability that EQW is cost-effective ranged from 76-99%. CONCLUSION: Results suggest that exenatide 2 mg once-weekly is cost-effective over a lifetime horizon compared to dulaglutide 1.5 mg QW, liraglutide 1.2 mg QD, liraglutide 1.8 mg QD, and lixisenatide 20 µg QD for the treatment of T2DM in adults not adequately controlled on metformin alone.