Cost-Effectiveness of Januvia versus Avandia as
Supplementary Treatment in Combination with Metformin
for Patients with Type 2 Diabetes
Verheggen BG1, van der Steen A1, Heeg BMS1, Vos CBJ2, van Hout BA1
Pharmerit
1Ph itBV, The Netherlands, Merck Sh D h BV Th N th l d
BV Th N th l d 2M k Sharp & Dohme BV, The Netherlands
Objective representing diabetes related Univariate and multivariate SEs were not inflated, multivariate
To assess the cost-effectiveness complications (see poster PMC11). sensitivity analyses were carried sensitivity analyses showed that
(CE) of Januvia versus Avandia as Estimates of disease progression, out. The added uncertainty due to 81% of the iterations showed gains
supplementary treatment in incidence in the sub models, disease the assumption of sustained in QALYs and cost savings.
combination with metformin, for related mortality, and all cause effectiveness is expressed by Conclusion
patients with type 2 diabetes in mortality, were derived from the inflating the standard errors used in
The base case results indicate that
whom metformin (in addition to United Kingdom Prospective the multivariate sensitivity analyses
the use of Januvia is cost saving and
diet and exercise) does not provide Diabetes Study. It has been assumed by a factor 3.
generates an increase in QALYs per
adequate glycemic control. that the drug efficacy and adverse Results patient. The Dutch Health Insurance
event results of an 18-week head-to
The model and the results were part Base case results are presented in Board (CVZ) concluded that the
head comparison of Januvia versus
of the reimbursement dossier of tables 1 and 2 and in figure 2. The model was valid but that the
Avandia supplementary to
Januvia in the Netherlands. (1) univariate sensitivity analyses resulting ICUR was not robust.
metformin is sustained during week
Methods revealed that results were most Based on the latter and the lack of
19-52. The analysis was conducted
sensitive to changes in HbA1c drop, long term safety data the CVZ
The DELTA model was used to from a societal perspective. Direct
LDL and SBP change. The concluded that the CE of Januvia
assess the costs and effects of and indirect costs were included.
acceptability curve showed a CE
p y was not adequately substantiated.
q y
Januvia 100mg in comparison to
J i 100 i i Effects were reported as (disease-
Eff d (di
probability of 74% at a willingness
Avandia 8mg (figure 1). This cohort free) life years and quality-adjusted
to pay of €20,000/QALY. When
model contains five sub models life years (QALYs).
Figure 1: Treatment comparisons and treatment switches Table 1. Base case results (life time horizon)
Life years QALY Costs
Strategy 1 Strategy 2
Januvia 16.615 12.735 €40,908
2nd line tx Metformin + Januvia Metformin + Avandia
Avandia 16.585 12.706 €41,187
3rd line tx Metformin + LD insulin Metformin + LD insulin
Incremental 0.030 0.029 -€279
4th line tx Metformin + HD insulin Metformin + HD insulin
Table 2. incremental results for sub models
Figure 2: Scattergram multivariate sensitivity analysis Incremental QALYs1 Incremental costs2
No complication 0.052 €69
€ 10,000
Macrovascular 0.013
-0 013 €137
-€137
Quadrants:
€ 8,000
South East: 59% disease
North East: 14%
€ 6,000
South West: 14%
North West: 13% Renal disease 0.001 -€51
€ 4,000
Blindness 0.002 €8
Difference in costs
€ 2,000
€0 Amputation 0.001 €11
-0.400 -0.300 -0.200 -0.100 0.000 0.100 0.200 0.300 0.400 0.500 0.600
-€ 2,000
Heart failure -0.013 €64
-€ 4,000 1Incremental QALY for patients with >1 complication (-0.002) are not included in the table
g ( ), yp g y ( ) ( )
2Incremental cost for drug treatment (-€262), hypoglycaemia (€0) and other death (€18) are not included
-€ 6,000
in the table
-€ 8,000
References:
-€ 10,000
1) Pharmacoeconomic dossier: Januvia; submitted at Dutch Health Insurance Board, April 2007
Difference in effects 2) Claxton K. The irrelevance of inference: a decision-making approach to the stochastic evaluation
of health care technologies. J Health Econ. 1999; 18:341-364.21
Comment on NL reimbursement process of Januvia: of collecting additional data. It is not clear what decision strategy
According to Bayesian decision analysis theory, decisions have to be made on encompasses the decision to reject the pharmacoeconomic analysis of
point estimates and estimates concerning uncertainty should be used to decide Januvia on the basis of “lack of robustness”. In the mean time, the Dutch
on additional research.(2) When following that theory, provisional
research (2) theory ministry of Health, did decide to reimburse Januvia®.
reimbursement should have been advised, potentially with the condition
This poster was presented at the ISPOR Congress, Dublin October 2007
This study was financially supported by Merck Sharp & Dohme BV