J.F. Elgart

Treatment of type 2 diabetes with saxagliptin: a pharmacoeconomic evaluation in Argentina

BackgroundThe increasing prevalence of diabetes and its inadequate management results in a heavy burden of the disease for the patients, the health and the productive system and the overall community. Consequently, it is necessary to have new effective drugs to treat people with diabetes to decrease such burden. DPP-4 inhibitors can help to cope with this demand, but its usage is challenged by its apparent high cost. The aim of the current study was to compare a simulated cost-effectiveness ratio of metformin (MET) plus one drug of the DPP-4 inhibitors family, saxagliptin (SAXA) or sulfonylurea (SU) treatment during a 20-year period, from the perspective of the social security system, in a cohort of people with Type 2 diabetes (T2DM) who did not attain glycosylated hemoglobin treatment target values only with MET.MethodsA discrete event simulation model (Cardiff diabetes model) based on UKPDS 68 was used to simulate disease progression and to estimate the economic and health treatment consequences in people with T2DM. The clinical efficacy parameters for SAXA administration were obtained from the literature; local standard costs were considered for drug acquisition, adverse events (AEs), and micro/macrovascular complications. Costs were expressed in US dollars (2009) with an annual 3.5% discount and a 20-year time horizon.ResultsThe SAXA + MET treated group had a lower number of non-fatal events than the SU + MET treated group. The model also predicted a lower number of fatal macrovascular events for the SAXA + MET group (149.6 vs. 152.8). The total cost of the SAXA + MET cohort was 15% higher than that of the SU + MET cohort. Treatment with SAXA + MET resulted in a higher number of quality-adjusted life years (QALYs) (9.54 vs. 9.32) and life-years gained (LYGs) (20.84 vs. 20.76) compared to those treated with SU + MET. The incremental cost per QALY and LYG gained was

Hospitalization Costs for Heart Failure in People with Type 2 Diabetes: Cost-Effectiveness of its Prevention Measured by a Simulated Preventive Treatment

7,374 and

The Cost of Diabetes Care Programs for Type 2 Diabetes in Argentina: A Probabilistic Sensitivity Analysis

20,490, respectively.ConclusionsAccording to the criteria proposed by the Commission on Macroeconomics and Health, the use of the combination SAXA + MET is highly cost-effective in Argentina.

Changes in quality of care and costs induced by implementation of a diabetes program in a social security entity of Argentina

OBJECTIVES To estimate the cost-consequence of interventions to prevent hospitalizations for heart failure (HF) in people with type 2 diabetes. METHODS In HF events (63) from type 2 diabetes-related hospitalizations (N = 462) recorded in an Argentine hospital (March 2004-April 2005), we verified 1) the presence of one metabolic HF predictor (glycosylated hemoglobin [HbA1c] value) before hospitalization; and 2) in a simulation model, the resources needed for its prevention controlling such predictor during 6 months before and after the event. Sensitivity analysis of HF risk reduction, hospitalization cost, and cost of different treatments to achieve HbA1c 7% or less was performed with a Monte Carlo simulation (10,000 iterations). RESULTS HF represented 14% of hospitalizations, with a 44% rehospitalization rate for the same cause. Due to the total estimated cost for an HF hospitalization event was

Diabetes primary prevention program: New insights from data analysis of recruitment period

437.31, the prevention attained using our simulated treatment was

Relation between cost of drug treatment and body mass index in people with type 2 diabetes in Latin America

2326.51. The number needed to treat to prevent an HF event under any of the proposed alternatives to reduce HbA1c would be 3.57 (95% confidence interval 2.00-16.67). The additional cost of the simulated treatment versus the real one oscillates between

Health inequalities and the impact on the prevalence of cardiovascular risk factors and chronic complications in Argentina: a study on national risk factors surveys

6423.91 and

[Education of people with type 2 diabetes through peers with diabetes: is it cost effective?].

8455.68. CONCLUSIONS HbA1c control to reduce the number of HF events would be economically beneficial for health care payers.

Obesidad en Argentina: epidemiología, morbimortalidad e impacto económico

Introduction: Structured diabetes care programs in Argentina are scarce and do not inform about their cost using micro costing techniques. Aim: To estimate the incremental costs of a health care program for type 2 diabetes without complications implemented at sub-national level in Argentina during 2005. Methods: United Kingdom Prospective Diabetes Study and Latin American Diabetes Association guidelines were used to identify which resources should be part of a diabetes program to implement in two Argentinean provinces – Cordoba and Misiones – with high and low socioeconomic characteristics, respectively. A micro costing approach was used to estimate costs from the perspective of a public health payer, taking a province without diabetes program as a comparative scenario. Probabilistic sensitivity analysis following Monte Carlo simulation was used to determine the number of visits and practices, probability of insulin treatment, combination therapy for hypertension, annual number of test strips and unit cost of all resources used. Results: The main component of the annual incremental cost per patient in both provinces was self-monitoring blood glucose (~50%), followed by treatment of diabetes, dyslipidemia and hypertension. The lowest cost corresponded to human resources ( 90%). Discussion: This study provides original evidence for Argentina that could facilitate the development and further evaluation of diabetes programs and resource use optimization in the public health care subsector in other provinces/ countries with comparable socioeconomic and health care settings.

Dapagliflozin versus sulfonylurea as an add-on therapy to metformin: A cost-effectiveness analysis in Colombia

Purpose To measure the impact of a diabetes and cardiovascular risk factors program implemented in a social security institution upon short- and long-term clinical/metabolic outcomes and costs of care. Methods Observational longitudinal cohort analysis of clinical/metabolic data and resource use of 300 adult male and female program participants with diabetes before (baseline) and 1 and 3 years after implementation of the program. Data were obtained from clinical records (Qualidiab) and the administration’s database. Results The implementation of the program in “real world” conditions resulted in an immediate and sustainable improvement of the quality of care provided to people with diabetes incorporated therein. We also recorded a more appropriate oral therapy prescription for hyperglycemia and cardiovascular risk factors (CVRFs), as well as a decrease of events related to chronic complications. This improvement was associated with an increased use of diagnostic and therapeutic resources, particularly those related to pharmacy prescriptions, not specifically used for the control of hyperglycemia and other CVRFs. Conclusion The implementation of a diabetes program in real-world conditions results in a significant short- and long-term improvement of the quality of care provided to people with diabetes and other CVRFs, but simultaneously increased the use of resources and the cost of diagnostic and therapeutic practices. Since controlled studies have shown improvement in quality of care without increasing costs, our results suggest the need to include management-control strategies in these programs for appropriate medical and administrative feedback to ensure the simultaneous improvement of clinical outcomes and optimization of the use of resources.