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Second-Line Pharmacotherapy for Type 2 Diabetes — Update [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2013 Jul. (CADTH Optimal Use Report, No. 3.1A.)

APPENDIX 12SENSITIVITY ANALYSES FROM 2010 CADTH PHARMACOECONOMIC REPORT

ScenarioResult ($/QALY)
Reference case analysisMet+SU vs. Met: $12,757
Met+AGI vs. Met+SU: $939,479
Met+TZD vs. Met+AGI:$4,621,828
Met+Meg is dominated by Met+SU
Met+DPP-4, Met+basal insulin, and Met+biphasic insulin are dominated by Met+TZD
All patients not on an insulin assumed to add insulin NPH (0.75 U/kg/day) when A1C ≥ 9%Met+SU vs. Met: $44,373
Met+AGI, Met+Meg, Met+TZD, Met+DPP-4, Met+basal insulin, and Met+biphasic insulin are dominated by Met+SU
Effect estimates from pairwise meta-analyses of RCTsMet+SU vs. Met: $13,080
Met+TZD vs. Met+SU: $465,004
Met+AGI is dominated by a blend of Met+SU and Met+TZD
Met+Meg is dominated by Met+SU
Met+DPP-4, Met+basaI insulin and Met+biphasic insulin are dominated by Met+TZD
Model assumes a 50% reduction in the price of blood glucose test stripsMet+SU vs. Met: $9,102
Met+AGI vs. Met+SU: $1,033,639
Met+TZD vs. Met+AGI: $4,621,828
Met+Meg is dominated by Met+SU
Met+DPP-4, Met+basal insulin, and Met+biphasic insulin are dominated by Met+TZD
No test strip use among non–hypoglycemia- inducing OADsMet+SU vs. Met: $47,023
Met+AGI vs. Met+SU: $56,612
Met+TZD vs. Met+AGI: $4,621,828
Met+Meg is dominated by Met+SU
Met+DPP-4, Met+baal insulin, and Met+biphasic insulin are dominated by Met+TZD
Reduction in HRQoL resulting from weight gainMet+SU vs. Met: $17,839
Met+AGI vs. Met+SU: $80,453
Met+Meg is dominated by Met+SU
Met+TZD, Met+DPP-4, Met+basal insulin, and Met+biphasic are dominated by Met+AGI
Disutilities for diabetes-related complications obtained from group of patients with type 2 diabetesMet+SU vs. Met: $11,694
Met+AGI vs. Met+SU: $575,841
Met+Meg is dominated by Met+SU
Met+TZD, Met+DPP-4, Met+basal insulin, and Met+biphasic are dominated by Met+AGI
Higher baseline rate of mild to moderate hypoglycemiaMet+SU vs. Met: $12,757
Met+AGI vs. Met+SU: $938,719
Met+TZD vs. Met+AGI: $4,619,894
Met+Meg is dominated by Met+SU
Met+DPP-4, Met+basaI insulin, and Met+biphasic are dominated by Met+TZD
No HRQoL decrement for fear of severe hypoglycemiaMet+SU vs. Met: $16,860
Met+AGI vs. Met+SU: $130,967
Met+TZD vs. Met+AGI: $4,924,369
Met+Meg is dominated by Met+SU
Met+DPP-4, Met+basal insulin, and Met+biphasic insulin are dominated by Met+TZD
Model incorporates increased risk of CHF and upper extremity fractures in patients using TZDs (safety data)Met+SU vs. Met: $12,757
Met+AGI vs. Met+SU: $939,479
Met+Meg is dominated by Met+SU
Met+TZD, Met+DPP-4, Met+basal insulin, and Met+biphasic are dominated by Met+AGI
Model incorporates reduced HRQoL associated with increased gastrointestinal symptoms among patients using AGIMet+SU vs. Met: $12,757
Met+TZD vs. Met+SU: $843,306
Met+Meg and Met+AGI are dominated by Met+SU
Met+DPP-4, Met+basal insulin, and Met+biphasic insulin are dominated by Met+TZD

A1C = glycated hemoglobin; AGI = alpha-glucosidase inhibitor; CHF = congestive heart failure; DPP-4 = dipeptidyl peptidase-4; HRQoL = health-related quality of life; Meg = meglitinide; Met = metformin; NPH = neutral protamine Hagedorn; RCT = randomized controlled trial; QALY = quality-adjusted life-year; SU = sulfonylurea; TZD = thiazolidinedione; U = units; vs. = versus.

Copyright © CADTH 2013.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

Cover of Second-Line Pharmacotherapy for Type 2 Diabetes — Update
Second-Line Pharmacotherapy for Type 2 Diabetes — Update [Internet].
CADTH Optimal Use Report, No. 3.1A.

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