Deerochanawong Chaicharn, Kosachunhanun Natapong, Gadekar Arvind V, Chotikanokrat Pitthaporn, Permsuwan Unchalee
Rajavithi Hospital, College of Medicine, Rangsit University, Ministry of Public Health, Bangkok 10400, Thailand.
Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Clinicoecon Outcomes Res. 2019 Jul 11;11:423-430. doi: 10.2147/CEOR.S201951. eCollection 2019.
Liraglutide, a once-daily subcutaneous glucagon-like peptide-1 (GLP-1) agonist, is approved for treatment of hyperglycemia in patients with type 2 diabetes mellitus (T2DM). For patients with established cardiovascular diseases, liraglutide has also been shown to reduce major cardiovascular events. However, its cost is relatively higher than other oral antidiabetic drugs. This study aims to compare the costs and benefits of liraglutide vs sitagliptin, in treating T2DM in Thailand.
This study consists of two parts. In part 1, the cost of keeping T2DM under control per patient (HbA1c<7.0% with no reported hypoglycemia and no body weight gain) with liraglutide (1.2 and 1.8 mg daily) was compared with using sitagliptin (100 mg daily). Costs were based on Thai local data. Clinical outcomes were based on head-to-head randomized controlled trials. Part 2 estimated the cost-per-controlled patient, based on major cardiovascular outcomes (cardiovascular death, nonfatal myocardial infarction, non-fatal stroke). Economic benefit was calculated as the reduction in cardiovascular outcomes.
In Thailand, liraglutide (1.8 mg daily) costs 7.37-times more than sitagliptin 100 mg. The cost per patient achieving a composite clinical endpoint (HbA1c<7.0%, with no weight gain and no hypoglycemic events) in patients with T2DM receiving liraglutide 1.8 mg is 2.80-times higher than patients receiving sitagliptin 100 mg. When cardiovascular benefits (reduced composite endpoint of major cardiovascular events, ie, cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke) were taken into account, it was found that liraglutide had lower cost than sitagliptin, resulting in estimated savings of 20,085 THB (620 USD) per patient per year.
The clinical benefits of liraglutide (HbA1c<7.0%, no hypoglycemia, no weight gain, reduced cardiovascular outcomes) partly offset its high price. Therefore, liraglutide should be considered as an appropriate treatment alternative to sitagliptin, particularly for T2DM patients with high cardiovascular risks.
利拉鲁肽是一种每日皮下注射一次的胰高血糖素样肽-1（GLP-1）激动剂，已被批准用于治疗2型糖尿病（T2DM）患者的高血糖。对于已确诊心血管疾病的患者，利拉鲁肽也已被证明可减少主要心血管事件。然而，其成本相对高于其他口服抗糖尿病药物。本研究旨在比较利拉鲁肽与西他列汀在泰国治疗T2DM的成本和效益。
本研究包括两个部分。在第1部分中，比较了使用利拉鲁肽（每日1.2毫克和1.8毫克）与西他列汀（每日100毫克）使每位T2DM患者血糖得到控制（糖化血红蛋白<7.0%，无低血糖报告且体重未增加）的成本。成本基于泰国当地数据。临床结果基于头对头随机对照试验。第2部分根据主要心血管结局（心血管死亡、非致命性心肌梗死、非致命性中风）估算了每位血糖得到控制患者的成本。经济效益以心血管结局的减少来计算。
在泰国，利拉鲁肽（每日1.8毫克）的成本比100毫克西他列汀高7.37倍。接受1.8毫克利拉鲁肽治疗的T2DM患者中，达到综合临床终点（糖化血红蛋白<7.0%，体重未增加且无低血糖事件）的每位患者成本比接受100毫克西他列汀治疗的患者高2.80倍。当考虑心血管益处（主要心血管事件的综合终点降低，即心血管死亡、非致命性心肌梗死和非致命性中风）时，发现利拉鲁肽的成本低于西他列汀，预计每位患者每年可节省20,085泰铢（620美元）。
利拉鲁肽的临床益处（糖化血红蛋白<7.0%，无低血糖，无体重增加，心血管结局降低）部分抵消了其高昂价格。因此，利拉鲁肽应被视为西他列汀的一种合适治疗替代方案，特别是对于心血管风险高的T2DM患者。
