Restricted accessOtherFirst published online 2008-01
Long-term costs and clinical outcomes associated with metformin-glibenclamide combination tablets (Glucovance®) in patients with type 2 diabetes sub-optimally controlled by metformin: a modelling study in the French setting
Most patients eventually become hyperglycaemic on metformin monotherapy. We modelled clinical and economic consequences for such patients of switching to a single-tablet metformin-glibenclamide combination (Glucovance®) or glibenclamide, or increasing metformin dosage.
Methods
A validated computer simulation model of diabetes projected long-term clinical and cost outcomes for the French setting, using data from a 16-week randomised controlled trial.
Results
Compared with metformin, Glucovance® 500/2.5 mg or 500/5 mg was associated with increased quality-adjusted life expectancy (0.45 and 0.27 quality-adjusted life-years [QALYs] respectively; base case analysis), reduced direct medical costs (by 3,331 and 2,026) and fewer diabetes-related complications. Compared with glibenclamide, Glucovance® 500/5 mg increased quality-adjusted life expectancy by 0.28 QALYs and reduced direct medical costs by 1,793.
Conclusions
From a third-party healthcare payer perspective in France, Glucovance® represents a dominant treatment option versus metformin or glibenclamide for patients sub-optimally controlled on metformin monotherapy.
UK Prospective Diabetes Study Group.Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet1998;352:837-53.
2.
Clinical Guidelines Task Force, International Diabetes Federation.2005Global Guideline for Type 2 Diabetes . Available at www.idf.org
3.
Nathan DM, Buse JB, Davidson MB et al. Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia2006;49:1711-21.
4.
Turner RC, Cull CA, Frighi V., Holman RRGlycaemic control with diet, sulphonylurea, metformin or insulin in patients with type 2 diabetes mellitus: Progressive requirement for multiple therapies (UKPDS 49). JAMA1999;281:2005-12.
5.
Scarpello JHB.Optimal dosing strategies for maximising the clinical response to metformin in type 2 diabetes. Br J Diabetes Vasc Dis2001;1:28-36.
6.
Marre M., Howlett H., Lehert P., Allavoine T.Improved glycaemic control with metformin-glibenclamide combined tablet therapy (Glucovance®) in Type 2 diabetic patients inadequately controlled on metformin . Diabet Med2002;19:673-80.
7.
Palmer AJ, Roze S., Valentine WJ et al. The CORE Diabetes Model: Projecting Long-term Clinical Outcomes, Costs and Cost-effectiveness of Interventions in Diabetes Mellitus (Types 1 and 2) to Support Clinical and Reimbursement Decision-making. Curr Med Res Opin2004;20(8
8.
suppl):5-26. 8. Stratton IM, Adler AI, Neil HA et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Br Med J2000;321:405-12.
9.
Palmer AJ, Roze S., Valentine W. et al. P Validation of the CORE Diabetes Model against Epidemiological and Clinical Studies. Curr Med Res Opin2004 ;20(suppl 1):S27-S40.
10.
Detournay B. , Cros S., Charbonnel B. et al. Managing type 2 diabetes in France: the ECODIA survey. Diabetes Metab2000;26:363-9.
11.
Fagnani F., Souchet T., Labed D.Incidence, management and cost of cardio-vascular and renal complications in French type 2 diabetic patients in 2001 [Abstract]. Value Health2003;5:206.
12.
Montagne O. , Chaix C., Harf A., Castaigne A., Durand-Zaleski I.Costs for acute myocardial infarction in a tertiary care centre and nationwide in France. Pharmacoeconomics2000;17:603-09.
13.
Levy P., Lechat P., Leizorovicz A., Levy E.A cost-minimization of heart failure therapy with bisoprolol in the French setting: an analysis from CIBIS trial data. Cardiac Insufficiency Bisoprolol Study. Cardiovasc Drugs Ther1998;12:301-05.
14.
LePen C. , Lilliu H., Keller T., Fiessinger S.The economics of TRACE. A cost-effectiveness analysis of trandolapril in postinfarction patients with left ventricular dysfunction. Pharmacoeconomics1998;14:49-58.
15.
Mullins CD, Sikirica M., Seneviratne V., Ahn J., Akhras KSComparisons of hypertension-related costs from multinational clinical studies . Pharmacoeconomics2004;22:1001-14.
16.
Levy E., Gabriel S., Dinet J.The comparative medical costs of atherothrombotic disease in European countries . Pharmacoeconomics2003;21:651-9.
17.
Palmer AJ, Annemans L., Roze S., Lamotte M., Rodby RA, Cordonnier D.An economic evaluation of irbesartan in the treatment of patients with type 2 diabetes, hypertension and nephropathy; cost-effectiveness of Irbesartan in Diabetic Nephropathy Trial (IDNT) in the Belgian, and French settings. Nephrol Dial Transplant2003;18:2059-66.
18.
Grueger J., O'Brien B., Caro J., Everhard F.The lifetime direct medical costs of managing diabetes and its complications in France [Abstract]. Value Health2001;4:504-05.
19.
Bonastre J. , Le Pen C., Soubrane G., Quentel G.The burden of age-related macular degeneration: results of a cohort study in two French referral centres. Pharmacoeconomics2003;21:181-90.
20.
Nghiem-Buffet MH, de Pouvourville G., Renard G., Ullern M., Boureau C., Chaine G.[Cost of managing cataracts. Evaluation of traditional hospitalization and ambulatory surgery] . Presse Med2001;30:1924-6.
21.
Ghatnekar O. , Persson U., Willis M., Odegaard K.Cost effectiveness of Becaplermin in the treatment of diabetic foot ulcers in four European countries . Pharmacoeconomics2001;19:767-78.
22.
Cnamts. LaClassification Commune des Actes Médicaux (CCAM) . 2002.
23.
24.
Tarn T., Smith M.Pharmacoeconomic guidelines around the world. ISPOR Connections2004;10:5-15.
25.
Briggs AH, Wonderling DE, Mooney CZPulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ1997;6:327-40.
26.
Garber AJ, Duncan TG, Goodman AM, Mills DJ, Rohlf JLEfficacy of metformin in type II diabetes: results of a double-blind, placebo-controlled, dose-response trial. Am J Med1997;103:491-7.
27.
Charpentier G., Genes N., Vaur L. et al. Control of diabetes and cardiovascular risk factors in patients with type 2 diabetes: a nationwide French survey . Diabetes Metab2003;29:152-8.
28.
Fox KM, Gerber Pharmd RA, Bolinder B., Chen J., Kumar S.Prevalence of inadequate glycemic control among patients with type 2 diabetes in the United Kingdom general practice research database: A series of retrospective analyses of data from 1998 through 2002. Clin Ther2006;28:388-95.
29.
Del Prato S. , Felton AM, Munro N., Nesto R., Zimmet P., Zinman B.Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal. Int J Clin Pract2005;59:1345-55.
30.
Veehof L., Stewart R., Haaijer-Ruskamp F., Jong BMThe development of polypharmacy. A longitudinal study. Fam Pract2000;17:261-7.
31.
Rubin RRAdherence to pharmacologic therapy in patients with type 2 diabetes mellitus . Am J Med2005;118 (suppl 5A):27S-34S.
32.
Dailey G., Kim MS, Lian JFPatient compliance and persistence with anti-hyperglycaemic therapy: evaluation of a population of type 2 diabetic patients. J Int Med Res2002;30:71-9.
33.
Melikian C. , White TJ, Vanderplas A., Derji CM, Chang E.Adherence to oral antidiabetic therapy in a managed care organisation: a comparison of monotherapy, combination therapy and fixed-dose combination therapy. Clin Ther2002;24:460-7.
34.
Duckworth W. , Marcelli M., Padden M. et al. Improvements in glycemic control in type 2 diabetes patients switched from sulfonylurea coadministered with metformin to glyburide-metformin tablets. J Manag Care Pharm2003;9:256-62.
35.
Kahn SE, Haffner SM, Heise MA et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med2006;355:2427-43.
