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Cost Effectiveness and Resource Allocation
Published in: Cost Effectiveness and Resource Allocation 1/2004

Open Access 01-12-2004 | Research

Health and economic impact of combining metformin with nateglinide to achieve glycemic control: Comparison of the lifetime costs of complications in the U.K

Authors: Alexandra J Ward, Maribel Salas, J Jaime Caro, David Owens

Published in: Cost Effectiveness and Resource Allocation | Issue 1/2004

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Abstract

Background

To reduce the likelihood of complications in persons with type 2 diabetes, it is critical to control hyperglycaemia. Monotherapy with metformin or insulin secretagogues may fail to sustain control after an initial reduction in glycemic levels. Thus, combining metformin with other agents is frequently necessary. These analyses model the potential long-term economic and health impact of using combination therapy to improve glycemic control.

Methods

An existing model that simulates the long-term course of type 2 diabetes in relation to glycosylated haemoglobin (HbA1c) and post-prandial glucose (PPG) was used to compare the combination of nateglinide with metformin to monotherapy with metformin. Complication rates were estimated for major diabetes-related complications (macrovascular and microvascular) based on existing epidemiologic studies and clinical trial data. Utilities and costs were estimated using data collected in the United Kingdom Prospective Diabetes Study (UKPDS). Survival, life years gained (LYG), quality-adjusted life years (QALY), complication rates and associated costs were estimated. Costs were discounted at 6% and benefits at 1.5% per year.

Results

Combination therapy was predicted to reduce complication rates and associated costs compared with metformin. Survival increased by 0.39 (0.32 discounted) and QALY by 0.46 years (0.37 discounted) implying costs of £6,772 per discounted LYG and £5,609 per discounted QALY. Sensitivity analyses showed the results to be consistent over broad ranges.

Conclusion

Although drug treatment costs are increased by combination therapy, this cost is expected to be partially offset by a reduction in the costs of treating long-term diabetes complications.
Appendix
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Literature
1.
Bagust A, Hopkinson PK, Maslove L, Currie CJ: The projected health care burden of Type 2 diabetes in the UK from 2000 to 2060. Diabetic Medicine 2002, 19: 1–5. 10.1046/j.1464-5491.19.s4.2.xPubMedCrossRef
2.
UK Prospective Diabetes Study Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998, 352: 837–53. 10.1016/S0140-6736(98)07019-6CrossRef
3.
McIntosh A, Hutchinson A, Home PD, Brown F, Bruce A, Damerell A, Davis R, Field R, Frost G, Marshall S, Davis R, Roddick J, Tesfayes S, Withers H, Suckling R, Smith S, Griffin S, Kaltenthaler E, Peters J: Clinical guidelines and evidence review for Type 2 diabetes: blood glucose management. Sheffield: Sc HARR, University of Sheffield 2001.
4.
Turner R, Cull C, Frighi V, Holman RR: Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus. Progressive requirement for multiple therapies (UKPDS 49). JAMA 1999, 281: 2005–12. 10.1001/jama.281.21.2005PubMedCrossRef
5.
Horton ES, Clinkingbeard C, Gatlin M, Foley J, Mallows S, Shen S: Nateglinide alone and in combination with metformin improves glycemic control by reducing mealtime glucose levels in type 2 diabetes. Diabetes Care 2000, 23: 1660–65.PubMedCrossRef
6.
Caro JJ, Klittich WS, Raggio G, Kavanagh P, O'Brien J, Shomphe LA, Flegel KM, Copley-Merriman C, Sigler C: Economic assessment of troglitazone as an adjunct to sulfonylurea therapy in the treatment of type 2 diabetes. Clin Ther 2000, 22: 116–27. 10.1016/S0149-2918(00)87983-7PubMedCrossRef
7.
Caro JJ, Ward A, O'Brien J: Lifetime Costs of Complications Resulting from Type 2 Diabetes in the U.S. Diabetes Care 2002, 25: 476–81.PubMedCrossRef
8.
Salas M, Ward A, Caro J: Health and economic effects of adding nateglinide to metformin to achieve dual control of glycosylated hemoglobin and postprandial glucose levels in a model of type 2 diabetes mellitus. Clin Ther 2002,24(10):1690–705. 10.1016/S0149-2918(02)80072-8PubMedCrossRef
9.
Caro JJ, Salas M, Ward AJ, Raggio G, O'Brien JA, Gruger J: Combination therapy for Type 2 Diabetes: What are the potential health and cost implications in Canada? Canadian Journal of Diabetes 2003,27(1):33–41.
10.
Cowie CC, Harris MI: Physical and metabolic characteristics of persons with diabetes. In Diabetes in America 2 Edition National Diabetes Data Group. Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, (NIH publ. No. 95–468 1995, 117–64.
11.
Fujimoto WY: Diabetes in Asian and Pacific Islander Americans. In Diabetes in America 2 Edition National Diabetes Data Group. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, NIH publ. no 95–468 1995, 661–82.
12.
Rewers M, Hamman RF: Risk factors for non-insulin-dependent diabetes. In:Diabetes in America 2 Edition National Diabetes Data Group, National Institutes of Health, NIH publication No 95–1468 1995, 179–220, 619.
13.
Eastman RC, Seibert CW, Harris , Gorden P: Implications of the Diabetes Control and Complications Trial. Diabetes Care 2001, 24: S28-S32.
14.
DECODE Study Group: Glucose tolerance and cardiovascular mortality. Comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med 2001, 161: 397–404. 10.1001/archinte.161.3.397CrossRef
15.
Glick H: The potential for CVD prevention by reducing postprandial hyperglycaemia. In Proceedings of the IDEG: Acapulco 2000.
16.
Eastman RC, Javitt JC, Herman WH, Dasbach EJ, Zbrozek AS, Dong F, Manninen D, Garfield SA, Copley-Merriman C, Maier W, Eastman JF, Kotsanos J, Cowie CC, Harris M: Model of complications of NIDDM. I. Model construction and assumptions. Diabetes Care 1997, 20: 725–34.PubMedCrossRef
17.
Mogensen CE: Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 1984, 310: 356–60.PubMedCrossRef
18.
Neil A, Hawkins M, Potok M, Thorogood M, Cohen D, Mann J: A prospective population-based study of microalbuminuria as a predictor of mortality in NIDDM. Diabetes Care 1993, 16: 996–1003.PubMedCrossRef
19.
Ballard DJ, Melton LJ, Dwyer MS, Trautmann JC, Chu CP, O'Fallon WM, Palumbo PJ: Risk factors for diabetic retinopathy: a population-based study in Rochester, Minnesota. Diabetes Care 1986, 9: 334–42.PubMedCrossRef
20.
Humphrey LL, Palumbo PJ, Butters MA, Hallett JW, Chu CP, O'Fallon M, Ballard DJ: The contribution of non-insulin dependent diabetes to lower extremity amputation in the community. Arch Intern Med 1994, 154: 885–92. 10.1001/archinte.154.8.885PubMedCrossRef
21.
Klein R, Klein BE, Moss SE, Davis MD, DeMets DL: The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Arch Ophthalmol 1989, 107: 244–49.PubMedCrossRef
22.
The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993, 329: 977–86. 10.1056/NEJM199309303291401CrossRef
23.
Nathan DM: Long-term complications of diabetes mellitus. N Engl J Med 1993, 328: 1676–85. 10.1056/NEJM199306103282306PubMedCrossRef
24.
American Diabetes Association: Implications of the Diabetes Control and Complications Trial. Diabetes Care 2001, 24: S2832.
25.
Pollet RJ, El-Kebbi IM: The applicability and implications of the DCCT to NIDDM. Diabetes Rev 1994, 2: 413–27.
26.
Eastman RC, Javitt JC, Herman WH, Dasbach EJ, Copley-Merriman C, Maier W, Dong F, Manninen D, Zbrozek AS, Kotsanos J, Garfield SA, Harris M: Model of complications of NIDDM. II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia. Diabetes Care 1997, 20: 735–44.PubMedCrossRef
27.
Barrett-Connor E, Ferrara A: Isolated postchallenge hyperglycemia and the risk of fatal cardiovascular disease in older women and men: the Rancho Bernardo Study. Diabetes Care 1998, 21: 1236–39.PubMedCrossRef
28.
The DECODE Study Group on behalf of the European Diabetes EpidemiologyGroup: Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet 1999, 354: 617–21. 10.1016/S0140-6736(98)12131-1CrossRef
29.
Clarke P, Gray A, Legood R, Briggs A, Holman R: The impact of diabetes-related complications on healthcare costs: results from the United Kingdom Prospective Diabetes Study (UKPD Study No. 65). Diabetic Medicine 2003, 20: 442–450. 10.1046/j.1464-5491.2003.00972.xPubMedCrossRef
30.
Lamping DL, Constantinovici N, Roderick P, Normand C, Henderson L, Harris S, Brown E, Gruen R, Victor C: Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study. Lancet 2000,4(356 (9241)):1543–50. 10.1016/S0140-6736(00)03123-8CrossRef
31.
Monthly Index of Medical Specialties Haymarket Publishing Services Ltd 2002.
32.
Clarke P, Gray A, Holman R: Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Med Decis Making 2002, 22: 340–49. 10.1177/027298902400448902PubMedCrossRef
33.
Lawrence WF, Grist TM, Brazy PC, Fryback DG: Magnetic resonance angiography in progressive renal failure: a technology assessment. Am J Kidney Dis 1995, 25: 701–709.PubMedCrossRef
34.
Guidance for manufacturers and sponsors (N0014) National Institute of Clinical Excellence 2001.
35.
Review of completed technology appraisals 2000/2001 Item 3 National Institute of Clinical Excellence Annual Public Meeting 18 July 2001.
36.
Alexander W, and South East Thames Diabetes Physicians Group: Diabetes care in a UK Health Region: Activity, facilities and costs. Diabet Med 1988, 5: 577–81.PubMedCrossRef
37.
Currie CJ, Williams DR, Peters JR: Patterns of in and out-patient activity for diabetes: a district survey. Diabet Med 1996, 13: 273–80.PubMedCrossRef
38.
Currie CJ, Morgan CLL, Peters JR: The epidemiology and cost of inpatient care for peripheral vascular disease, infection, neuropathy, and ulceration in diabetes. Diabetes Care 1998, 21: 42–8.PubMedCrossRef
39.
Morgan CL, Currie CJ, Hunt J, Evans JD, Rogers C, Stott N, Peters JR: Relative activity and referral patterns for diabetes and non-diabetes in general practice. Diabet Med 2000, 17: 230–5. 10.1046/j.1464-5491.2000.00208.xPubMedCrossRef
40.
UK prospective diabetes study (UKPDS) group: Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998, 352: 854–65. 10.1016/S0140-6736(98)07037-8CrossRef
41.
Gray A, Raikou M, McGuire A, Fenn P, Stevens R, Cull C, Stratton I, Adler A, Holman R, Turner R, on behalf of the UKPDS study group: Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41). BMJ 2000, 320: 1373–78. 10.1136/bmj.320.7246.1373PubMedCentralPubMedCrossRef
42.
Clarke P, Gray A, Adler A, Stevens R, Raikou M, Cull C, Stratton I, Holman R: Cost-effectiveness analysis of intensive blood-glucose control with metformin in overweight patients with Type II diabetes (UKPDS No 51). Diabetologia 2001,44(3):298–304. 10.1007/s001250051617PubMedCrossRef
43.
Walters DP, Gatling W, Houston C, Mullee MA, Julious SA, Hill RD: Mortality in diabetic subjects: an eleven year follow-up of a community based population. Diabet Med 1994, 11: 968–73.PubMedCrossRef
44.
Morrish NJ, Stevens LK, Head J, Fuller H, Jarrett , Keen H: A prospective study of mortality among middle-aged diabetic patients (the London cohort of the WHO Multinational Study of Vascular Disease in Diabetics) I: causes and death rates. Diabetologia 1990, 33: 538–41.PubMedCrossRef
45.
Turner RC, Millns H, Neil HA, Stratton IM, Manley SE, Matthews DR, Holman RR, for the United Kingdom Prospective Diabetes Study Group: Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS 23). BMJ 1998, 316: 823–8.PubMedCentralPubMedCrossRef
46.
The DECODE Study Group: Consequences of the new diagnostic criteria for diabetes in older men and women. Diabetes Care 1999, 22: 1667–71.CrossRef
47.
American Diabetes Association: Postprandial blood glucose. Diabetes Care 2001, 24: 775–8.CrossRef
48.
Turner R, Cull C, Holman R, United Kingdom Prospective Diabetes Study 17: A 9-year update of a randomized, controlled trial on the effect of improved metabolic control on complications in non-insulin dependent diabetes mellitus. Ann Intern Med 1996, 124: 136–45.PubMedCrossRef
Metadata
Title
Health and economic impact of combining metformin with nateglinide to achieve glycemic control: Comparison of the lifetime costs of complications in the U.K
Authors
Alexandra J Ward
Maribel Salas
J Jaime Caro
David Owens
Publication date
01-12-2004
Publisher
BioMed Central
Published in
Cost Effectiveness and Resource Allocation / Issue 1/2004
Electronic ISSN: 1478-7547
DOI
https://doi.org/10.1186/1478-7547-2-2