Objectives: Sulphonylureas (SU) and insulin are used routinely in the management of T2DM but are associated with weight gain and increased risk of hypoglycaemia. Canagliflozin is a new insulin-independent oral glucose lowering agent with added benefits of weight loss, blood pressure reduction and no increased risk of hypoglycaemia. This analysis estimated the cost-effectiveness of canagliflozin compared to either SU or insulin in patients failing to achieve glycaemic control on metformin monotherapy in Ireland. Methods: The Economic and Health Outcomes Model of T2DM (ECHO-T2DM) was used to simulate the lifetime outcomes and costs associated with canagliflozin (100mg, titrated to 300mg as needed to maintain glycaemic control) versus SU and versus insulin glargine. Patient characteristics and treatment effects for the SU comparison were sourced from a head-to-head randomized clinical trial vs. glimepiride. Hypoglycaemia rates were halved to reflect gliclazide MR (the preferred SU in Ireland). Patient characteristics for the insulin glargine comparison were obtained from the pooled canagliflozin add-on to metformin RCTs; treatment effects were sourced from a network meta-analysis. Costs were localised and inflated to 2013 euros. Utilities were sourced from the literature. Costs and outcomes were discounted at 5% annually. Results: The incremental costs, QALY gains and ICERs associated with canagliflozin were € 2,404, 0.215 QALYs and € 11,191 per QALY gained, respectively, versus SU and € 2,352, 0.228 QALYs and € 10,305 per QALY gained, respectively, versus insulin glargine. Key drivers were decreased hypoglycaemia and lower weight-related disutility versus both comparators, as well as better HbA1c durability versus SU. In both cases, using an acceptable Irish willingness-to-pay threshold, the probability of being cost-effective was in excess of 97%. Sensitivity analyses support the robustness of these results. Conclusions: These simulations suggest that canagliflozin is a cost-effective treatment choice versus both gliclazide MR and insulin glargine in patients failing to control glycaemia on metformin alone.
Bacon, T., Willis, M., Johansen, P., Neslusan, C., Nuhoho, S., & Worbes-Cerezo, M. (2014). The Cost-Effectiveness of Canagliflozin Verse Insulin-Secretagogues (Sulphonylureas) or Insulin In Patients With Type 2 Diabetes Mellitus (T2dm) As An Add-On To Metformin In Ireland. Value in Health, 17(7), A346. https://doi.org/10.1016/j.jval.2014.08.704