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Cited by 23Diabetes Treatment and ManagementHealth Systems, Economic Evaluations, Quality of LifeHeart Failure Treatment and Management

Cost-effectiveness of first-line versus delayed use of combination dapagliflozin and metformin in patients with type 2 diabetes

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Chin, Ken Lee, Ofori-Asenso, Richard, Si, Si, Hird, Thomas R., Magliano, Dianna J., Zoungas, Sophia, Liew, Danny·2019·Scientific Reports
DOI 10.1038/s41598-019-40191-8PMC PMC6397228
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Abstract

The present study sought to evaluate the cost-effectiveness of first-line (immediate) versus delayed use of combination dapagliflozin and metformin in patients with type 2 diabetes, from the perspective of the Australian healthcare system. We developed a Markov model to simulate the progress of subjects with type 2 diabetes. Decision analysis was applied to assess the cost-effectiveness of first-line combination dapagliflozin and metformin versus first-line metformin monotherapy followed by gradual addition of dapagliflozin over time. Transition probabilities, costs (in Australian dollars) and utility data were derived from published sources. All costs, years of life lived and quality adjusted life years (QALYs) lived were discounted at an annual rate of 5%. Over a 20-year model period, first-line use of combination dapagliflozin and metformin was predicted to reduce the onset of hospitalisation of heart failure, cardiovascular deaths and all cause deaths by 5.5%, 57.6% and 29.6%, respectively. An additional 2.5 years of life (discounted) and 1.9 QALYs (discounted) would be gained per patient, at a cost of AUD $23,367 (discounted) per person. These figures equated to AUD $9,535 per years of life saved (YoLS) and AUD $12,477 per QALYs saved. Sensitivity analyses indicated the results to be robust. Compared to first-line metformin monotherapy followed by gradual addition of dapagliflozin, first-line use of combination dapagliflozin and metformin is likely to be a cost-effective approach to the management of Australians with type 2 diabetes mellitus.

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Authors
Chin, K. L., Ofori-Asenso, R., Si, S., Hird, T. R., Magliano, D. J., Zoungas, S., & Liew, D.
Affiliations
  • The University of Melbourne (AU)
  • Monash University (AU)
  • Baker Heart and Diabetes Institute (AU)
  • The George Institute for Global Health (AU)
Corresponding author
Liew, Danny
ORCID
Venue
Scientific Reports
Publisher
Springer Science and Business Media LLC
Published
2019-03-01
Volume
9
Issue
1
Pages
3256-3256
ISSN
2045-2322 (ISSN-L)
DOI
10.1038/s41598-019-40191-8
PMC
PMC6397228
OpenAlex
W2916474915
Cited by
23
References
47
Citations by year
2026: 3 · 2025: 1 · 2024: 4 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 5 · 2019: 1
FWCI
2.64
Type
journal article
Language
en
Open access
Licence
Locations
  • Scientific Reports (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Monash University Research Portal (Monash University) (submittedVersion, cc-by)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
type 2 diabetes, dapagliflozin, metformin, combination therapy, first-line therapy, delayed treatment initiation, cost-effectiveness, quality-adjusted life years, heart failure hospitalization, cardiovascular mortality, all-cause mortality, Markov model, Australian health system
MeSH terms
Benzhydryl Compounds, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Drug Therapy, Combination, Glucosides, Humans, Metformin, Probability

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