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Cost-Effectiveness of Dapagliflozin as Add-On to Metformin for the Treatment of Type 2 Diabetes Mellitus in Greece

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Abstract

Background and Objective

Type 2 diabetes mellitus (T2DM) is a chronic progressive disease that has been spread worldwide over the past three decades and associated with increased morbidity and mortality resulting in considerable socioeconomic implications for national healthcare systems. Effective management of disease is highly needed ensuring patients receive the best possible care within the available budget. The objective of this study was to evaluate the long-term cost-effectiveness of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT-2) inhibitor, compared with a sulfonylurea (SU) or a dipeptidyl-peptidase-4 inhibitor (DPP-4i), when added to metformin, in T2DM patients inadequately controlled on metformin alone in Greece.

Methods

The published and validated Cardiff diabetes model, a lifetime micro-simulation model, was adapted to a Greek healthcare setting to determine the incidence of micro- and macro-vascular complications and diabetes-specific and all-cause mortality. Clinical, cost, and utility data were retrieved from literature and assigned to model parameters to calculate total quality-adjusted life-years (QALYs) and total costs as well as incremental cost-effectiveness ratios (ICERs). The analysis was conducted from the perspective of a third-party payer in Greece. Uncertainty surrounding important model parameters was explored with univariate and probabilistic sensitivity analyses (PSA).

Results

Over a patient’s lifetime, dapagliflozin was associated with 0.48 and 0.04 incremental QALYs compared with SU and DPP-4i, respectively, at additional costs of €5142 and €756, respectively. The corresponding ICERs were €10,623 and €17,695 per QALY gained versus the treatment with SU and DPP-4i, respectively. Results were robust across various univariate and scenario analyses. At the defined willingness-to-pay threshold of €34,000 per QALY gained, PSA estimated that treatment with dapagliflozin had a 100 % and 79.7 % probability of being cost-effective relative to the SU and DPP-4i treatments.

Conclusions

Dapagliflozin in combination with metformin was shown to be a cost-effective treatment alternative for patients with T2DM whose metformin regimen does not provide sufficient glycemic control in a Greek healthcare setting.

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Acknowledgments

The authors would like to thank AstraZeneca Greece for sponsoring this study.

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Authors and Affiliations

  1. Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece

    Charalampos Tzanetakos & Nikos Maniadakis

  2. First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece

    Nicholas Tentolouris

  3. Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), “Aghia Sophia” Children`s Hospital, Athens, Greece

    Georgia Kourlaba

Authors
  1. Charalampos Tzanetakos
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Corresponding author

Correspondence to Charalampos Tzanetakos.

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Funding

This study was funded by AstraZeneca Greece. However, the study sponsor had no interference in the study design, data collection, data analysis, or writing of the manuscript.

Conflicts of interest

CT, NT, GK and NM have no personal or financial conflicts of interest.

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Tzanetakos, C., Tentolouris, N., Kourlaba, G. et al. Cost-Effectiveness of Dapagliflozin as Add-On to Metformin for the Treatment of Type 2 Diabetes Mellitus in Greece. Clin Drug Investig 36, 649–659 (2016). https://doi.org/10.1007/s40261-016-0410-2

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