Cost and effectiveness of exenatide combined with insulin, compared to exenatide combined with oral hypoglycaemic agents

Abstract

There have been few studies investigating the use of GLP-1 agonists in patients with insulin-treated type 2 diabetes and none looking at the costing. We compared the efficacy and relative cost of adding exenatide treatment to patients with type 2 diabetes receiving either oral hypoglycaemic agents (OHAs) or insulin. Patients were recruited from West Suffolk Hospital Diabetes Centre. Data were acquired retrospectively from 207 patients completing six months of treatment. Of 207 patients, 188 demonstrated good clinical progress with a mean HbA1c reduction of 1.6% (p<0.0001) and weight loss of 6.9kg (p<0.0001). Nineteen patients discontinued exenatide as HbA1c reduction did not achieve the NICE target (0.4%; p=0.29), but they did achieve significant weight loss (5.6kg; p<0.0001). The 188 patients continuing on exenatide were sub-divided into insulin-treated (n=88) or tablet-treated (n=100). At six months, tablet-treated patients achieved an HbA1c reduction of 1.6% (p<0.0001) and weight loss of 6.5kg (p<0.0001). Insulin-treated patients achieved similar results: HbA1c reduction 1.6% (p<0.0001), weight loss 7.3kg (p<0.0001). After six months of exenatide treatment, the mean reduction in daily insulin dose was 48 units/person in the insulin-treated group. In the tablet-treated group, the cost of diabetic medication (per person/month) after six months was £54.90 above baseline, whereas in the insulin-treated group this was only £36.20 above baseline, because the reduction in insulin dose offset the cost of exenatide. It was concluded that exenatide is clinically effective in both insulin-treated and tablet-treated type 2 diabetes, but is more cost effective in those originally treated with insulin. Copyright © 2011 John Wiley & Sons.