Cost-Effectiveness Analysis of Thiazolidinediones in Uncontrolled Type 2 Diabetic Patients Receiving Sulfonylureas and Metformin in Thailand (2008)

Cost-Effectiveness Analysis of Thiazolidinediones in Uncontrolled Type 2 Diabetic Patients Receiving Sulfonylureas and Metformin in Thailand.

Suphachai Chirakup^1,2 Nathorn Chaiyakunapruk^1,3,4 Usa Chaikledkeaw^5,6 Petcharat Pongcharoensuk⁵ Boonsong Ongphiphadhanakul⁷ Stephane Roze⁸ William J. Valentine⁸ Andrew J. Palmer⁸

¹Department of Pharmacy Practice, School of Pharmacy, Naresuan University, Phitsanulok, Thailand;
²Faculty of Pharmacy, Payup University, Chiangmai,Thailand;
³Ministry of Public Health, Bangkok,Thailand;
⁴School of Population Health,The University of Queensland, Brisbane, Australia;
⁵Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand;
⁶Health Intervention and Technology Assessment Program, Ministry of Public Health, Bangkok,Thailand;
⁷Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;
⁸CORE-Center for Outcomes Research, Binningen/Basel, Switzerland

Objective

The national essential drug committee in Thailand suggested that only one of thiazolidinediones be included in hospital formulary but little was know about their costeffectiveness values. This study aims to determine an incremental cost-effectiveness ratio of pioglitazone 45 mg compared with rosiglitazone 8 mg in uncontrolled type 2 diabetic patients receiving sulfonylureas and metformin in Thailand.

Methods

A Markov diabetes model (Center for Outcome Research model) was used in this study. Baseline characteristics of patients were based on Thai diabetes registry project. Costs of diabetes were calculated mainly from Buddhachinaraj hospital. Nonspecific mortality rate and transition probabilities of death from renal replacement therapy were obtained from Thai sources. Clinical effectiveness of thiazolidinediones was retrieved from a meta-analysis. All analyses were based on the government hospital policymaker perspective. Both cost and outcomes were discounted with the rate of 3%. Base-case analyses were analyzed as incremental cost per quality-adjusted life year (QALY) gained.A series of sensitive analyses were performed.

Results

In base-case analysis, the pioglitazone group had a better clinical outcomes and higher lifetime costs. The incremental cost per QALY gained was 186,246 baht (US$ 5389). The acceptability curves showed that the probability of pioglitazone being cost-effective was 29% at the willingness to pay of one time of Thai gross domestic product per capita (GDP per capita). The effect of pioglitazone on %HbA1c decrease was the most sensitive to the final outcomes.

Conclusions

Our findings showed that in type 2 diabetic patients who cannot control their blood glucose under the combination of sulfonylurea and metformin, the use of pioglitazone 45 mg fell in the cost-effective range recommended by World Health Organization (one to three times of GDP per capita) on average, compared to rosiglitazone 8 mg. Nevertheless, based on sensitivity analysis, its probability of being cost-effective was quite low. Hospital policymakers may consider our findings as part of information for the decision-making process. Keywords: cost-effectiveness analysis, pioglitazone, rosiglitazone, thiazolidinediones.

Link: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Chaikledkeaw%20U%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus