Abstract

Background

The difference between the costs of the newer and older glucose-lowering drugs (GLMs) has been steadily increasing since 2010. In 2018, newer drugs cost 8–12 times more than older drugs (except for insulin). This study aimed to understand how the cost change influenced the cost-effectiveness of the newer GLMs.

Methods

Based on our previous literature review on US-based cost-effectiveness studies comparing newer (i.e. dipeptidyl peptidase-4 inhibitors (DPP4), glucagon-like peptide 1 receptor agonists (GLP1-RA), and sodium-glucose transport protein 2 inhibitors) with older GLMs, we identified 12 studies that reported the cost-effectiveness of newer drugs based on drug costs estimated before 2010. We updated the corresponding cost-effectiveness of each study by replacing the old cost estimates with 2018 estimates from the 2018 IBM MarketScan Commercial Claims Databases. The time window and willingness to pay threshold were consistent with the original studies.

Results

Only 8% of the original studies suggested that the older drugs were cost-effective. However, 58% of studies were in favor of the older drugs after the cost update. Among the four studies comparing newer drugs with thiazolidinediones, all the original results favored newer drugs. However, all studies suggested thiazolidinedione to be cost-effective in the updated analysis. For the four studies comparing newer drugs with sulfonylureas, two studies suggested the sulfonylureas to be cost-effective after the cost update. All four studies suggested newer drugs to be cost-effective when compared with insulin in the original study. Only 1 flipped its conclusion when 2018 costs were used. Our sensitivity analysis shows that our results are robust under a 30% rebate.

Conclusion

Significant changes in the cost of GLMs have impacted the economic value of different GLM classes substantially. More cost-effectiveness analyses are warranted to support the drug choice in T2DM management.

中文翻译：

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美国新型降糖药物的成本效益下降：2010-2018 年

摘要

背景

自 2010 年以来，新旧降糖药 (GLM) 的成本差异一直在稳步扩大。2018 年，新药的成本是旧药的 8-12 倍（胰岛素除外）。本研究旨在了解成本变化如何影响新 GLM 的成本效益。

方法

基于我们之前对美国成本效益研究的文献回顾，比较了较新的（即二肽基肽酶 4 抑制剂 (DPP4)、胰高血糖素样肽 1 受体激动剂 (GLP1-RA) 和钠-葡萄糖转运蛋白 2 抑制剂）与较旧的 GLM，我们确定了 12 项研究，这些研究根据 2010 年之前估计的药物成本报告了新药的成本效益。我们更新了每项研究的相应成本效益，用 2018 年 IBM MarketScan Commercial Claims 的 2018 年估计替换旧的成本估计数据库。时间窗口和支付意愿阈值与原始研究一致。

结果

只有 8% 的原始研究表明，较旧的药物具有成本效益。然而，在成本更新后，58% 的研究支持较旧的药物。在比较新药与噻唑烷二酮的四项研究中，所有原始结果都支持新药。然而，所有研究都表明噻唑烷二酮在更新的分析中具有成本效益。对于比较新药与磺脲类药物的四项研究，两项研究表明磺脲类药物在成本更新后具有成本效益。与原始研究中的胰岛素相比，所有四项研究都表明新药具有成本效益。当使用 2018 年的成本时，只有 1 人推翻了结论。我们的敏感性分析表明，在 30% 的回扣下，我们的结果是稳健的。

结论

GLM 成本的显着变化对不同 GLM 类别的经济价值产生了重大影响。需要更多的成本效益分析来支持 T2DM 管理中的药物选择。