Artículos de revistas
Cost-effectiveness And Budget Impact Of Saxagliptine As Additional Therapy To Metformin For The Treatment Of Diabetes Mellitus Type 2 In The Brazilian Private Health System
Registro en:
Revista Da Associacao Medica Brasileira. , v. 58, n. 3, p. 294 - 301, 2012.
1044230
10.1590/S0104-42302012000300008
2-s2.0-84864843720
Autor
Nita M.E.
Eliaschewitz F.G.
Ribeiro E.
Asano E.
Barbosa E.
Takemoto M.
Donato B.
Rached R.
Rahal E.
Institución
Resumen
Objectives: To compare costs and clinical benefits of three additional therapies to metformin (MF) for patients with diabetes mellitus type 2 (DM2). Methods: A discrete event simulation model was built to estimate the cost-utility ratio (cost per quality-adjusted life years [QALY]) of saxagliptine as an additional therapy to MF when compared to rosiglitazone or pioglitazone. A budget impact model (BIM) was built to simulate the economic impact of saxagliptine use in the context of the Brazilian private health system. Results: The acquiring medication costs for the hypothetical patient group analyzed in a time frame of three years were R$10,850,185, R$14,836,265 and R$ 14,679,099 for saxagliptine, pioglitazone and rosiglitazone, respectively. Saxagliptine showed lower costs and greater effectiveness in both comparisons, with projected savings for the first three years of R$ 3,874 and R$3,996, respectively. The BIM estimated cumulative savings of R$417,958 with the repayment of saxagliptine in three years from the perspective of a health plan with 1,000,000 covered individuals. Conclusion: From the perspective of private paying source, the projection is that adding saxagliptine with MF save costs when compared with the addition of rosiglitazone or pioglitazone in patients with DM2 that have not reached the HbA1c goal with metformin monotherapy. The BIM of including saxagliptine in the reimbursement lists of health plans indicated significant savings on the three-year horizon. © 2012 Elsevier Editora Ltda. All right reserved. 58 3 294 301 King, H., Aubert, R.E., Herman, W.H., Global burden of diabetes, 1995-2025: Prevalence, numerical estimates, and projections (1998) Diabetes Care, 21 (9), pp. 1414-1431 Barceló, A., Rajpathak, S., Incidence and prevalence of diabetes mellitus in the Americas (2001) Rev Panam Salud Pública, 10 (5), pp. 300-308 Yach, D., Stuckler, D., Brownell, K.D., Epidemiologic and economic consequences of the global epidemics of obesity and diabetes (2006) Nat Med, 12 (1), pp. 62-66 Bosi, P.L., Carvalho, A.M., Contrera, D., Casale, G., Pereira, M.A., Gronner, M.F., Prevalência de diabetes melito e tolerância à glicose diminuída na população urbana de 30 a 79 anos da cidade de São Carlos, São Paulo (2009) Arq Bras Endocrinol Metab, 53 (6), pp. 726-732 Costa, J.S.D., Olinto, M.T.A., Assunção, M.C.F., Gigante, D.P., McEdo, S., Menezes, A.M.B., Prevalence of diabetes mellitus in southern Brazil: A population-based study (2006) Rev Saúde Pública, 40 (3), pp. 542-545 Schaan, B.D.A., Harzheim, E., Gus, I., Cardiac risk profile in diabetes mellitus and impaired fasting glucose (2004) Rev Saúde Pública, 38 (4), pp. 529-536 Torquato, M.T.D.C.G., Montenegro Junior, R.M., Viana, L.A.L., Souza, R.A.H.G.D., Lanna, C.M.M., Lucas, J.C.B., Prevalence of diabetes mellitus and impaired glucose tolerance in the urban population aged 30-69 years in Ribeirão Preto (São Paulo), Brazil (2003) São Paulo Med J, 121 (6), pp. 224-230 Malerbi, D.A., Franco, L.J., Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30-69 yr. The Brazilian Cooperative Group on the Study of Diabetes Prevalence (1992) Diabetes Care, 15 (11), pp. 1509-1516 Schaan, B.D., Harzheim, E., Gus, I., Cardiac risk profile in diabetes mellitus and impaired fasting glucose (2004) Rev Saúde Pública, 38 (4), pp. 529-536 Oliveira, A.F., Valente, J.G., Leite, I.D.C., Shcramm, J.M.D.A., Azevedo, A.S.R., Gadelha, A.M.J., Global burden of disease attributable to diabetes mellitus in Brazil (2009) Cad Saúde Pública, 25 (6), pp. 1234-1244 (2002) The World Health Report 2002: Reducing risks, promoting healthy life, , http://www.who.int/whr/2002/en/whr02_en.pdf, World Health Organization. Geneva. Available from Panarotto, D., Salibe, M., Oliveira, D., Teles, A.R., Controle glicêmico de pacientes diabéticos tipo 2 nos serviços público e privado de Saúde (2009) Arq Bras Endocrinol Metab, 53 (6), pp. 733-740 Mendes, A.B.V., Fittipaldi, J.A.S., Neves, R.C.S., Chacra, A.R., Moreira, E.D., Prevalence and correlates of inadequate glycaemic control: Results from a nationwide survey in 6,671 adults with diabetes in Brazil (2010) Acta Diabetologica, 47 (2), pp. 137-145 Gomes, M.D.B., Gianella, D., Faria, M., Tambascia, M., Fonseca, R.M., Réa, R., Prevalence of type 2 diabetic patients within the targets of care guidelines in daily clinical practice: A multi-center study in Brazil (2006) Rev Diabet Stud, 3 (2), pp. 73-78 Stratton, I.M., Adler, A.I., Neil, H.A., Matthews, D.R., Manley, S.E., Cull, C.A., Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study (2000) BMJ, 321 (7258), pp. 405-412 Gerich, J., The importance of tight glycemic control (2005) Am J Med, 118 (SUPPL. 9A), pp. 7S-11S Chaves, L., Anselmi, M., Barbeira, C., Hayashida, M., Estudo da sobrevida de pacientes submetidos a hemodiálise e estimativa de gastos no município de Ribeirão Preto-SP (2002) Rev Esc Enferm USP, 36 (2), pp. 193-199 Milman, M.H.S.A., Leme, C.B.M., Borelli, D.T., Kater, F.R., Baccili, E.C.D.C., Rocha, R.C.M., Pé diabético: Avaliação da evolução e custo hospitalar de pacientes internados no Conjunto Hospitalar de Sorocaba (2001) Arq Bras Endocrinol Metab, 45 (5), pp. 447-451 Rezende, K.F., Nunes, M.A.P., Melo, N.H., Malerbi, D., Chacra, A.R., Ferraz, M., Internações por pé diabético: Comparação entre o custo direto estimado e o desembolso do SUS (2008) Arq Bras Endocrinol Metab, 52 (3), pp. 523-530 Rosenstock, J., Aguilar-Salinas, C., Klein, E., Nepal, S., List, J., Chen, R., Effect of saxagliptin monotherapy in treatment-naïve patients with type 2 diabetes (2009) Curr Med Res Opin, 25 (10), pp. 2401-2411 Rosenstock, J., Sankoh, S., List, J., Glucose-lowering activity of the dipeptidyl peptidase-4 inhibitor saxagliptin in drug-naive patients with type 2 diabetes (2008) Diabetes Obes Metab, 10 (5), pp. 376-386 DeFronzo, R.A., Hissa, M.N., Garber, A.J., Luiz Gross, J., Yuyan Duan, R., Ravichandran, S., The efficacy and safety of saxagliptin when added to metformin therapy in patients with inadequately controlled type 2 diabetes with metformin alone (2009) Diabetes Care, 32 (9), pp. 1649-1655 Jadzinsky, M., Pfützner, A., Paz-Pacheco, E., Xu, Z., Allen, E., Chen, R., Saxagliptin given in combination with metformin as initial therapy improves glycaemic control in patients with type 2 diabetes compared with either monotherapy: A randomized controlled trial (2009) Diabetes Obes Metab, 11 (6), pp. 611-622 Nita, M.E., Secoli, S.R., Nobre, M., Ono-Nita, S., Health technology assessment: Research methodology (2009) Arq Gastroenterol, 46 (4), pp. 252-256 Nita, M.E., Secoli, S.R., Nobre, M., Ono-Nita, S.K., Campino, A.C.C., Sarti, F.M., (2010) Avaliação de tecnologias em saúde: Evidência clínica, análise econômica e análise de decisão, , Porto Alegre: Artmed Clarke, P.M., Gray, A.M., Briggs, A., Farmer, A.J., Fenn, P., Stevens, R.J., A model to estimate the lifetime health outcomes of patients with type 2 diabetes: The United Kingdom prospective diabetes study (UKPDS) outcomes model (UKPDS no. 68) (2004) Diabetologia, 47 (10), pp. 1747-1759 Eliaschewitz, F.G., Bahia, L., Cintra, M., Franco, L., Nita, M.E., Treatment patterns and achievement of therapeutic goals in a cohort of type 2 diabetes mellitus patients treated in the brazilian private health care system (PHCS): Initial reports of DIAPS 79 study (2010) Value Health, 13 (7), pp. A301. , DIAPS 79 Study Group Yki-Järvinen, H., Kauppinen-Mäkelin, R., Tiikkainen, M., Vähätalo, M., Virtamo, H., Nikkilä, K., Insulin glargine or NPH combined with metformin in type 2 diabetes: The LANMET study (2006) Diabetologia, 49 (3), pp. 442-451 Polonsky, T., Mazzone, T., Davidson, M., The clinical implications of the CHICAGO study for the management of cardiovascular risk in patients with type 2 diabetes mellitus (2009) Trends Cardiovasc Med, 19 (3), pp. 94-99 Tewart, M.W., Cirkel, D.T., Furuseth, K., Donaldson, J., Biswas, N., Starkie, M.G., Effect of metformin plus roziglitazone compared with metformin alone on glycaemic control in well-controlled Type 2 diabetes (2006) Diabet Med, 23 (10), pp. 1069-1078 Mwamburi, M., Xu, Y., Fahrbach, K., (2009) A systematic review and meta-analysis of clinical efficacy and safety of mixed treatments for type 2 diabetes Mellitus, , Lexington, MA: United BioSource Corporation Phung, O.J., Scholle, J.M., Talwar, M., Coleman, C., Effect of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycemia in type 2 diabetes (2010) JAMA, 303 (14), pp. 1410-1418 (2010) Health survey for England, , http://www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/HealthSurveyForEngland/Healthsurveyresults/index.htm, Department of Health (England). Department of Health [cited 2011 Nov 22]. Available from Clarke, P., Gray, A., Holman, R., Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62) (2002) Med Decis Making, 22 (4), pp. 340-349 Currie, C.J., Morgan, C.L., Poole, C.D., Sharplin, P., Lammert, M., McEwan, P., Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes (2006) Curr Med Res Opin, 22 (8), pp. 1523-1534 Belon, A.P., Maria, P., Bergamo, S., Berti, M., Barros, D.A., Luis, C., Diabetes em idosos: Perfil sócio-demográfico e uso de serviços de saúde (2008) XVI Encontro Nacional de Estudos Populacionais, , In: ABEP Caxambu-MG set/out 29-03. Belo Horizonte: ABEP2008 Waugh, N., Cummins, E., Royle, P., Clar, C., Marien, M., Richter, B., Newer agents for blood glucose control in type 2 diabetes: Systematic review and economic evaluation (2010) Health Technol Assess, 14 (36), pp. 1-248 Newer agents for blood glucose control in type 2 diabetes (2009) NICE Short Clinical Guidance, 87, pp. 1-102. , National Institute for Health and Clinical Excellence Li, R., Zhang, P., Barker, L.E., Chowdhury, F.M., Zhang, X., Cost-effectiveness of interventions to prevent and control diabetes mellitus: A systematic review (2010) Diabetes Care, 33 (8), pp. 1872-1894 Schwarz, B., Gouveia, M., Chen, J., Nocea, G., Jameson, K., Cook, J., Cost-effectiveness of sitagliptin-based treatment regimens in European patients with type 2 diabetes and haemoglobin A1c above target on metformin monotherapy (2008) Diabetes Obes Metab, 10 (SUPPL. 1), pp. 143-155 McEwan, P., Evans, M., Bergenheim, K., A population model evaluating the costs and benefits associated with different oral treatment strategies in people with type 2 diabetes (2010) Diabetes Obes Metab, 12 (7), pp. 623-630 Stettler, C., Allemann, S., Jüni, P., Cull, C.A., Holman, R.R., Egger, M., Glycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: Meta-analysis of randomized trials (2006) Am Heart J, 152 (1), pp. 27-38 Adler, A.I., Erqou, S., Lima, T.A., Robinson, A., Association between glycated haemoglobin and the risk of lower extremity amputation in patients with diabetes mellitus-review and meta-analysis (2010) Diabetologia, 53 (5), pp. 840-849