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A Zebrafish Model of Diabetes Mellitus and Metabolic Memory
Published on: February 28, 2013
Cost-Effectiveness of Highly Effective Glucose-Lowering Agents: Do Current Practices Optimize Clinical and Economic
Meredith Hoog1, Alice Minghetti2, William J Valentine3
1Eli Lilly and Company, Indianapolis, USA.
Introduction:
Advances in type 2 diabetes (T2D) treatment have expanded therapeutic options, but evidence on optimal treatment sequencing for long-term outcomes remains limited. This study evaluated six common T2D treatment pathways in the US using long-term modeling.
Methods:
A literature review of guidelines and published data identified 495 treatment sequences across 77 studies. The six most frequently reported pathways were selected for modeling analyses using the PRIME T2D Model. Metformin was first-line therapy in all modeled pathways. Empagliflozin 10 mg (EMPA) was added as second-line therapy in four pathways, followed by either tirzepatide 10 mg (TZP), liraglutide 1.8 mg (LIRA), semaglutide 1.0 mg (SEMA) or dulaglutide 3.0 mg (DULA) as third-line therapy. In two pathways, TZP or SEMA were introduced as second-line agents, followed by EMPA as the third-line therapy. Basal and basal-bolus insulin were fourth- and fifth-line therapies in all analyses. Treatment intensification was modeled every 3 years or when glycated hemoglobin (HbA1c) exceeded 7.5%.
Results:
When used as third-line treatment, more efficacious agents improved clinical outcomes and increased costs relative to comparators. As the most efficacious third-line therapy, TZP was associated with incremental cost-effectiveness ratios (ICERs) of $50,545, $25,563, and $8,173 per quality-adjusted life years (QALYs) gained versus LIRA, SEMA and DULA, respectively, assuming intensification every 3 years. When used as second-line therapy, more efficacious agents further improved clinical outcomes but also contributed to higher direct costs over patients' lifetimes. Second-line TZP was associated with ICERs of $59,434 per QALY gained versus second-line SEMA, when intensification at HbA1c 7.5% was applied.
Conclusions:
Initiating more efficacious therapies early in T2D treatment may improve long-term outcomes. Though associated with higher upfront costs, these therapies may reduce complication-related costs over time. Use of modern, efficacious therapies earlier in disease management may be a cost-effective strategy for healthcare payers.
Insights
Early use of effective type 2 diabetes (T2D) therapies, like tirzepatide, improves long-term outcomes and may be cost-effective despite higher initial costs. This modeling study analyzed T2D treatment pathways.
Area of Science:
- Pharmacoeconomics and Health Outcomes Research
- Endocrinology and Metabolism
- Diabetes Mellitus Management
Background:
- Limited evidence exists on optimal sequencing of type 2 diabetes (T2D) treatments for long-term patient outcomes.
- Expanding therapeutic options for T2D necessitate evaluating different treatment pathway strategies.
Purpose of the Study:
- To evaluate and compare the long-term outcomes and costs of six common T2D treatment pathways in the US.
- To assess the impact of treatment sequencing, particularly the early introduction of highly efficacious agents.
Main Methods:
- Utilized the PRIME T2D Model for long-term simulation of T2D treatment pathways.
- Modeled six common pathways, all starting with metformin, with varying sequences of second- and third-line therapies including empagliflozin, tirzepatide, liraglutide, semaglutide, dulaglutide, and insulin.
- Treatment intensification was simulated every 3 years or when HbA1c exceeded 7.5%.
Main Results:
- Introducing more efficacious agents earlier, such as tirzepatide as second- or third-line therapy, improved clinical outcomes.
- Tirzepatide as third-line therapy demonstrated favorable incremental cost-effectiveness ratios (ICERs) compared to liraglutide, semaglutide, and dulaglutide.
- Earlier use of effective therapies, while increasing upfront costs, may reduce long-term complication-related expenditures.
Conclusions:
- Early initiation of highly efficacious therapies in T2D management can lead to improved long-term health outcomes.
- Despite higher initial investment, employing modern, effective treatments earlier in the disease course represents a potentially cost-effective strategy for healthcare systems.
- Treatment sequencing plays a crucial role in optimizing long-term T2D management and resource utilization.
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