Pharmacoeconomic evaluation of Sitagliptin compared to sulfonylruea derivatives in patients with type 2 diabetes not controlled by Metformin monotherapy
Study objective: To perform a comparative pharmacoeconomic analysis of the therapy combinations: sitagliptin with metformin, and sulfonylureas with metformin in patients with type 2 diabetes on metformin monotherapy whose target glycemic goal is not reached with diet and exercise.
Materials and methods: A time horizon of 10 years was used to conduct the comparative pharmacoeconomic analysis. The following were used as reference data for the calculations: drug prices, as registered in the VED [Vital Essential Drugs]; earlier publications on the cost of complications; and data on treatment outcomes and hypoglycaemia rates in comparator groups from the JADE modelling study, based upon the data from clinical study 024 for the Russian patient population.
Results: Total medical expenditures for one patient came to 449,927 rubles in the sitabliptin+metformin group, and 415,385 rubles in the sulfonylurea+metformin group – a difference of 7.7%. Within this, the share of costs for the actual drugs was 53% and 11%, respectively, indicating a greater burden due to longterm consequences (hypoglycaemia, complications from type 2 diabetes, transitioning to insulin) for the sulfonylurea group. When converted to 10,000 patients, the cost of the drugs in the sitagliptin group was 2,149 million rubles higher, and the expenditures for complications, including hypoglycaemia and insulin therapy, were 1,559 million rubles lower. Thus, in the sitagliptin group – unlike the sulfonylurea group – 410,000 cases of hypoglycaemia were prevented, as well as 40 cases of macro- and microvascular complications. Conclusion: the results suggest that the combination use of sitagliptin + metformin is pharmacoeconomically justified when compared to sulfonylurea + metformin to treat type 2 diabetes patients.