Publicação
The place of DPP-4 inhibitors in the treatment algorithm of diabetes type 2 : a systematic review of cost-effectiveness studies
| Resumo: | Regarding this work an actualization has been made to the thesis delivered in January of 2015. As this is a field of rapid evolution a new systematic review has been made in May 2015 with the retrieval of new studies published in the years of 2014 and 2015. This new review did not change the methods and conclusions from the former one. The objectives are to conduct a systematic review of cost-effectiveness, cost-utility and cost-benefit studies of DPP-4 inhibitors for diabetes treatment versus other antidiabetics. Regarding the methods three investigators searched the CRD York, Tufts CEA Registry, MEDLINE databases through May 2015. We revised all potentially relevant titles and abstracts, and subsequently screened full-text articles, according to inclusion criteria. The studies should be available as a full-text publication and published in English, French, Spanish, or Portuguese. A critical appraisal of the methodology and reporting was performed using the 35 item version of the BMJ checklist. Regarding the results a total of 295 studies were identified, of which 20 after the 2nd screening. Compared to sulphonylureas, the ICER varied between €924-13,931/QALY for saxagliptin, €5,949-20,350/QALY for sitagliptin and €9,072/QALY for vildagliptin, all as add-on to metformin. Compared to insulin, saxagliptin presented an ICER of €6,100/QALY (with sulphonylurea) and €6,790/QALY (with metformin). Compared to sitagliptin, liraglutide had an ICER that varied between €10,436-32,869/QALY as second line therapy. Finally, a study on GLP-1 agonists established an ICER of €37,463/QALY versus DPP-4 inhibitors. The majority of the studies were based on clinical trials of high quality; differences in ratios were essentially due to differences in the costs of resources across countries. Finally the conclusions are that according to commonly accepted thresholds, DDP-4 inhibitors are cost-effective versus sulphonylureas, and liraglutide versus sitagliptin for diabetes type 2. Recent evidence demonstrates that GLP-1 agonists are cost-effective versus DPP-4 inhibitors, possibly questioning the national current therapeutic guidelines. |
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| Autores principais: | Baptista, Alexandre de Sousa Calaça Pereira |
| Assunto: | Diabetes Cost-effectiveness studies DPP-4 inhibitors Systematic reviews Teses de mestrado - 2015 |
| Ano: | 2015 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Regarding this work an actualization has been made to the thesis delivered in January of 2015. As this is a field of rapid evolution a new systematic review has been made in May 2015 with the retrieval of new studies published in the years of 2014 and 2015. This new review did not change the methods and conclusions from the former one. The objectives are to conduct a systematic review of cost-effectiveness, cost-utility and cost-benefit studies of DPP-4 inhibitors for diabetes treatment versus other antidiabetics. Regarding the methods three investigators searched the CRD York, Tufts CEA Registry, MEDLINE databases through May 2015. We revised all potentially relevant titles and abstracts, and subsequently screened full-text articles, according to inclusion criteria. The studies should be available as a full-text publication and published in English, French, Spanish, or Portuguese. A critical appraisal of the methodology and reporting was performed using the 35 item version of the BMJ checklist. Regarding the results a total of 295 studies were identified, of which 20 after the 2nd screening. Compared to sulphonylureas, the ICER varied between €924-13,931/QALY for saxagliptin, €5,949-20,350/QALY for sitagliptin and €9,072/QALY for vildagliptin, all as add-on to metformin. Compared to insulin, saxagliptin presented an ICER of €6,100/QALY (with sulphonylurea) and €6,790/QALY (with metformin). Compared to sitagliptin, liraglutide had an ICER that varied between €10,436-32,869/QALY as second line therapy. Finally, a study on GLP-1 agonists established an ICER of €37,463/QALY versus DPP-4 inhibitors. The majority of the studies were based on clinical trials of high quality; differences in ratios were essentially due to differences in the costs of resources across countries. Finally the conclusions are that according to commonly accepted thresholds, DDP-4 inhibitors are cost-effective versus sulphonylureas, and liraglutide versus sitagliptin for diabetes type 2. Recent evidence demonstrates that GLP-1 agonists are cost-effective versus DPP-4 inhibitors, possibly questioning the national current therapeutic guidelines. |
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