Comparative effectiveness and cost-effectiveness of cardioprotective glucose-lowering therapies for type 2 diabetes in Brazil: a Bayesian network model

Health Economics Review

Research

Beatriz Luchiari¹  Isabella Bonilha¹  Wilson Nadruz¹  Joaquim Barreto¹  Andrei C. Sposito²  Luiz Sergio F. de Carvalho³  Ana Claudia Cavalcante Nogueira⁴  Filipe A. Moura⁵  Thomas Gaziano⁶  J. Michael Gaziano⁷  Abrão Abuhab⁸ 

[1]Cardiology Division, Unicamp Medical School, São Paulo, SP, Brazil

[2]Cardiology Division, Unicamp Medical School, São Paulo, SP, Brazil

[3]Atherosclerosis and Vascular Biology Laboratory (Atherolab), State University of Campinas (Unicamp), 13084-971, Sao Paulo, Campinas, Brazil

[4]Cardiology Division, Unicamp Medical School, São Paulo, SP, Brazil

[5]Clarity Healthcare Intelligence, Jundiaí, SP, Brasil

[6]Cardiology Division, Unicamp Medical School, São Paulo, SP, Brazil

[7]Escola Superior de Ciências da Saúde (ESCS), Brasília, Distrito Federal, Brazil

[8]Cardiology Division, Unicamp Medical School, São Paulo, SP, Brazil

[9]TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

[10]Department of Cardiovascular Medicine, Brigham & Women’s Hospital, Boston, MA, USA

[11]Department of Medicine, Harvard Medical School, Boston, MA, USA

[12]Heart Institute (InCor), Do Hospital das Clínicas - FMUSP, Sao Paulo, Brazil

关键词: Pioglitazone;    SGLT2i;    GLP1-RA;    Cost-effectiveness;    Glucose-lowering therapy;    Cardiovascular disease;   

DOI  :  10.1186/s13561-023-00466-3

 received in 2023-01-20, accepted in 2023-10-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe escalating prevalence of type 2 diabetes (T2DM) poses an unparalleled economic catastrophe to developing countries. Cardiovascular diseases remain the primary source of costs among individuals with T2DM, incurring expenses for medications, hospitalizations, and surgical interventions. Compelling evidence suggests that the risk of cardiovascular outcomes can be reduced by three classes of glucose-lowering therapies (GLT), including SGLT2i, GLP-1A, and pioglitazone. However, an evidence-based and cost-effective protocol is still unavailable for many countries. The objective of the current study is to compare the effectiveness and cost-effectiveness of GLT in individuals with T2DM in Brazil.MethodsWe employed Bayesian Networks to calculate the incremental cost-effectiveness ratios (ICER), expressed in international dollars (Int$) per disease-adjusted life years [DALYs] averted. To determine the effectiveness of GLT, we conducted a systematic review with network meta-analysis (NMA) to provide insights for our model. Additionally, we obtained cardiovascular outcome incidence data from two real-world cohorts comprising 851 and 1337 patients in primary and secondary prevention, respectively. Our cost analysis took into account the perspective of the Brazilian public health system, and all values were converted to Int$.ResultsIn the NMA, SGLT2i [HR: 0.81 (95% CI 0.69–0.96)], GLP-1A [HR: 0.79 (95% CI 0.67–0.94)], and pioglitazone [HR: 0.73 (95% CI 0.59–0.91)] demonstrated reduced relative risks of non-fatal cardiovascular events. In the context of primary prevention, pioglitazone yielded 0.2339 DALYs averted, with an ICER of Int$7,082 (95% CI 4,521–10,770) per DALY averted when compared to standard care. SGLT2i and GLP-1A also increased effectiveness, resulting in 0.261 and 0.259 DALYs averted, respectively, but with higher ICERs of Int$12,061 (95% CI: 7,227–18,121) and Int$29,119 (95% CI: 23,811–35,367) per DALY averted. In the secondary prevention scenario, all three classes of treatments were deemed cost-effective at a maximum willingness-to-pay threshold of Int$26,700. Notably, pioglitazone consistently exhibited the highest probability of being cost-effective in both scenarios.ConclusionsIn Brazil, pioglitazone presented a higher probability of being cost-effective both in primary and secondary prevention, followed by SGLT2i and GLP-1A. Our findings support the use of cost-effectiveness models to build optimized and hierarchical therapeutic strategy in the management of T2DM.Trial registrationCRD42020194415.

【 授权许可】

CC BY   
© Springer-Verlag GmbH Germany, part of Springer Nature 2023

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