Cost–effectiveness analysis of empagliflozin compared with glimepiride in patients with Type 2 diabetes in China
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: The study assesses the cost–effectiveness of empagliflozin versus glimepiride in patients with Type 2 diabetes and uncontrolled by metformin alone in China, based on the EMPA-REG H2H-SU trial. Materials & methods: A calibrated version of the IQVIA Core Diabetes Model was used. Cost of complications and utility were taken from literature. The Chinese healthcare system perspective and 5% discounting rates were applied. Results: Empagliflozin+metformin provides additional quality-adjusted life-years (0.317) driven by a reduction in the number of cardiovascular and renal events, for an additional cost of $1382 (CNY9703) compared with glimepiride+metformin. Conclusion: Empagliflozin is cost-effective treatment versus glimepiride applying a threshold of $30,290 (CNY212,676).
Supplementary Material
File (suppl_file.docx)
- Download
- 40.82 KB
References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
The 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 352(9131), 837–853 (1998).
2.
Gourzoulidis G, Tzanetakos C, Ioannidis I et al. Cost–effectiveness of empagliflozin for the treatment of patients with Type 2 diabetes mellitus at increased cardiovascular risk in Greece. Clin. Drug Investig. 38(5), 417–426 (2018).
3.
Zelniker TA, Wiviott SD, Raz I et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet 393(10166), 31–39 (2019).
4.
Ridderstrale M, Rosenstock J, Andersen KR, Woerle HJ, Salsali A, EMPA-REG H2H-SU trial investigators. Empagliflozin compared with glimepiride in metformin-treated patients with type 2 diabetes: 208-week data from a masked randomized controlled trial. Diabetes Obes. Metab. 20(12), 2768–2777 (2018).
5.
International Diabetes Federation (IDF). Dibetes Atlas. Ninth edition (2019). https://diabetesatlas.org/upload/resources/material/20200302_133351_IDFATLAS9e-final-web.pdf
6.
Rahman W, Solinsky PJ, Munir KM, Lamos EM. Pharmacoeconomic evaluation of sodium-glucose transporter-2 (SGLT2) inhibitors for the treatment of type 2 diabetes. Expert Opin. Pharmacother. 20(2), 151–161 (2019).
7.
McEwan P, Foos V, Palmer JL, Lamotte M, Lloyd A, Grant D. Validation of the IMS CORE Diabetes Model. Value Health 17(6), 714–724 (2014).
• A description of the IQVIA Core Diabetes Model structure is provided.
8.
Das SR, Everett BM, Birtcher KK et al. 2018 ACC Expert Consensus Decision Pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J. Am. Coll. Cardiol. 72(24), 3200–3223 (2018).
9.
Hayes AJ, Leal J, Gray AM, Holman RR, Clarke PM. UKPDS outcomes model 2: a new version of a model to simulate lifetime health outcomes of patients with type 2 diabetes mellitus using data from the 30 year United Kingdom Prospective Diabetes Study: UKPDS 82. Diabetologia 56(9), 1925–1933 (2013).
• A description of the risk equation used to predict diabetes complication is detailed.
10.
Kengne AP. The ADVANCE cardiovascular risk model and current strategies for cardiovascular disease risk evaluation in people with diabetes. Cardiovasc. J. Afr. 24(9-10), 376–381 (2013).
11.
Ahmad Kiadaliri A, Clarke PM, Gerdtham UG et al. Predicting changes in cardiovascular risk factors in Type 2 diabetes in the post-UKPDS era: longitudinal analysis of the Swedish National Diabetes Register. J. Diabetes Res. 24134 (2013).
12.
Cederholm J, Eeg-Olofsson K, Eliasson B et al. Risk prediction of cardiovascular disease in type 2 diabetes: a risk equation from the Swedish National Diabetes Register. Diabetes Care 31(10), 2038–2043 (2008).
13.
Folsom AR, Chambless LE, Duncan BB, Gilbert AC, Pankow JS. Prediction of coronary heart disease in middle-aged adults with diabetes. Diabetes Care 26(10), 2777–2784 (2003).
14.
Davis WA, Knuiman MW, Davis TM. An Australian cardiovascular risk equation for type 2 diabetes: the Fremantle Diabetes Study. Intern. Med. J. 40(4), 286–292 (2010).
15.
Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 105(3), 310–315 (2002).
16.
Fonseca V, Gill J, Zhou R, Leahy J. An analysis of early insulin glargine added to metformin with or without sulfonylurea: impact on glycaemic control and hypoglycaemia. Diabetes Obes. Metab. 13(9), 814–822 (2011).
17.
World Health Organization (WHO). Defined Daily Dose (DDD) (2020). www.whocc.no/ddd/definition_and_general_considera/
18.
Clinicaltrials.gov. Efficacy and safety of empagliflozin (BI 10773) with metformin in patients with type 2 diabetes (2016). https://clinicaltrials.gov/ct2/show/NCT01167881
• This reference provides a link to the trial design and features and on the clinical data produced and considered in the analyses produced in this manuscript.
19.
Li T, Wan X, Ma J, Wu B. Cost–effectiveness of primary prevention with statin treatment for chinese patients with Type 2 diabetes. Adv. Ther. 35(12), 2214–2223 (2018).
20.
Bagust A, Beale S. Modelling EuroQol health-related utility values for diabetic complications from CODE-2 data. Health Econ. 14(3), 217–230 (2005).
21.
Yaozh.com. (2020). www.yaozh.com/
23.
National Development and Reform Commission (NDRC). Rules of Drug Price Difference (2011). www.ndrc.gov.cn/xxgk/zcfb/tz/201112/t20111201_964344.html, https://www.ndrc.gov.cn/xxgk/zcfb/tz/201112/W020190905511109587604.pdf
24.
Foos V, Wang K, McEwan P et al. Assessing the burden of Type 2 diabetes in China considering the current status-quo management and implications of improved management using a modeling approach. Value Health Reg. Issues 18, 36–46 (2018).
25.
IQVIA China Hospital Pharmaceutical Audit database (2019).
26.
Liu GE, Wu JH et al. China PharmaceuEconomics: Evaluations and Guidance, 2015 Edition. (2015).
27.
Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S. Thresholds for the cost–effectiveness of interventions: alternative approaches. Bull. World Health Organ. 93(2), 118–124 (2015).
28.
China NBoSo. GDP per capita (2020). www.stats.gov.cn/tjsj/zxfb/202002/t20200228_1728913.html
29.
Zinman B, Wanner C, Lachin JM et al. Empagliflozin, Cardiovascular outcomes, and mortality in Type 2 diabetes. N. Engl. J. Med. 373(22), 2117–2128 (2015).
30.
Ramos M, Foos V, Ustyugova A, Hau N, Gandhi P, Lamotte M. Cost–effectiveness analysis of empagliflozin in comparison to sitagliptin and saxagliptin based on cardiovascular outcome trials in patients with Type 2 diabetes and established cardiovascular disease. Diabetes Ther. 10(6), 2153–2167 (2019).
• A similar study has been published recently using similar methodology in which analyses were run on patients with Diabetes and established cardiovascular disease.
31.
Ramos M, Ustyugova A, Hau N, Lamotte M. Cost–effectiveness of empagliflozin compared with liraglutide based on cardiovascular outcome trials in Type II diabetes. J. Comp. Eff. Res. 9(11), 781–794 (2020).
•• A similar study has been published recently using similar methodology in which analyses were run on patients with Diabetes and established cardiovascular disease.
32.
Peng M, Tianbi L, Suodi Z. Empagliflozin in type 2 diabetes mellitus patients with high cardiovascular risk: a model-based cost-utility analysis in China. Diabetes Metab. Syndr. Obes. 13, 2823–2831 (2020).
33.
Gao L, Zhao FL, Li SC. Cost-utility analysis of liraglutide versus glimepiride as add-on to metformin in type 2 diabetes patients in China. Int. J. Technol. Assess. Health Care 28(4), 436–444 (2017).
34.
Hu S, Deng X, Ma Y, Li Z, Wang Y, Wang Y. Cost-Utility analysis of dapagliflozin versus saxagliptin treatment as monotherapy or combination therapy as add-on to metformin for treating Type 2 diabetes mellitus. Appl. Health Econ. Health Policy 19(1), 69–79 (2021).
35.
Xie X, Vondeling H. Cost-utility analysis of intensive blood glucose control with metformin versus usual care in overweight type 2 diabetes mellitus patients in Beijing, P.R. China. Value Health 11(Suppl. 1), S23–S32 (2008).
36.
McEwan P, Bennett H, Khunti K et al. Assessing the cost–effectiveness of sodium-glucose cotransporter-2 inhibitors in type 2 diabetes mellitus: a comprehensive economic evaluation using clinical trial and real-world evidence. Diabetes Obes Metab. 22(12), 2364–2374 (2020).
•• Provides additional evidence on the cost–effectiveness profile of sodium-glucose cotransporter-2 in China and other locations.
37.
Shao H, Zhai S, Zou D et al. Cost–effectiveness analysis of dapagliflozin versus glimepiride as monotherapy in a Chinese population with type 2 diabetes mellitus. Curr. Med. Res. Opin. 33(2), 359–369 (2017).
38.
Palmer J, Gibbs M, Scheijbeler H et al. Cost–effectiveness of switching to biphasic insulin aspart in poorly-controlled type 2 diabetes patients in China. Adv. Ther. 25(8), 752–774 (2008).
Information & Authors
Information
Published In
Pages: 469 - 480
PubMed: 33576249
Copyright
© 2021 Mafalda Ramos. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
History
Received: 16 December 2020
Accepted: 14 January 2021
Published online: 12 February 2021
Keywords:
Topics
Authors
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Cost–effectiveness analysis of empagliflozin compared with glimepiride in patients with Type 2 diabetes in China. (2021) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2020-0284
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Ian W. Campbell, Kerstin M. G. Brand, Ulrike Gottwald-Hostalek, Julian Dettenbach, Evaluating Cost-Effectiveness in Relation to the Supporting Clinical Evidence Across the Type 2 Diabetes Continuum: A Review of Metformin and SGLT2is, Advances in Therapy, 10.1007/s12325-026-03592-6, (2026).
- Huiyuan Zhang, Jiaojiao Chen, Quan Zhao, Bei Zhang, Cost-utility analysis of empagliflozin compared with dapagliflozin in patients with type 2 diabetes in China, Frontiers in Public Health, 10.3389/fpubh.2025.1566101, 13, (2025).
- Mari Pesonen, Virpi Jylhä, Eila Kankaanpää, Adverse drug events in cost-effectiveness models of pharmacological interventions for diabetes, diabetic retinopathy, and diabetic macular edema: a scoping review, JBI Evidence Synthesis, 10.11124/JBIES-23-00511, 22, 11, (2194-2266), (2024).
- İsmail Keleş, Aynur Koyuncu, Ayla Yava, Nermin Olgun, Examination of Type 2 Diabetes Risk, Behavioural and Family Risk Factors, and Type 2 Diabetes Awareness in Healthcare Professionals Vocational School Students: The case of the Eastern Anatolian region of Turkey, Bingöl Üniversitesi Sağlık Dergisi, 10.58605/bingolsaglik.1419824, 5, 1, (19-28), (2024).
- Mohammed AlHarbi, Abdullah Othman, Ahmed Ali Nahari, Ahmed Hamdan Al-Jedai, Daniel Cuadras, Faisal Almalky, Fayez AlAzmi, Hajer Yousef Almudaiheem, Hamad AlShubrumi, Hameed AlSwat, Homaid AlSahafi, Kamelia Sindi, Khadija Basaikh, Majed AlQahtani, Mark Lamotte, Moataz Yahia, Mohamed El-Khedr Hassan, Mohammed AlMutlaq, Mohammed AlRoaly, Somaya AlZelaye, Zein AlGhamdi, Burden of Illness of Type 2 Diabetes Mellitus in the Kingdom of Saudi Arabia: A Five-Year Longitudinal Study, Advances in Therapy, 10.1007/s12325-023-02772-y, 41, 3, (1120-1150), (2024).
- Zixuan He, Xianqin Huang, Dingyi Chen, Guoan Wang, Yuezhen Zhu, Huangqianyu Li, Sheng Han, Luwen Shi, Xiaodong Guan, Sponsorship bias in published pharmacoeconomic evaluations of national reimbursement negotiation drugs in China: a systematic review, BMJ Global Health, 10.1136/bmjgh-2023-012780, 8, 11, (e012780), (2023).
- Wayne H‐H Sheu, Yutaka Seino, Elise Chia‐Hui Tan, Daisuke Yabe, Kyoung Hwa Ha, Masaomi Nangaku, Wook‐Jin Chung, Koichi Node, Atsutaka Yasui, Wei‐Yu Lei, Sunwoo Lee, Anastasia Ustyugova, Riho Klement, Anouk Deruaz‐Luyet, Moe H Kyaw, Dae Jung Kim, Healthcare resource utilization in patients treated with empagliflozin in East Asia, Journal of Diabetes Investigation, 10.1111/jdi.13728, 13, 5, (810-821), (2022).
