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Cost-effectiveness of diabetes treatment sequences to inform step therapy policies.

Publication ,  Journal Article
Hung, A; Jois, B; Lugo, A; Slejko, JF
Published in: Am J Manag Care
March 1, 2020

OBJECTIVES: Cost-effectiveness estimates are useful to a health plan when they are specific to a utilization management policy question. To help inform a step therapy policy decision, this study assessed the 3-year cost-effectiveness of adding a sodium-glucose cotransporter 2 (SGLT2) inhibitor versus switching to a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in patients with type 2 diabetes who are on metformin and a dipeptidyl peptidase-4 (DPP-4) inhibitor from both private and public payer perspectives in the United States. STUDY DESIGN: Cost-effectiveness analysis. METHODS: A decision-analytic model was built incorporating goal glycated hemoglobin (A1C) achievement as the effectiveness measure, as well as adverse effect and discontinuation rates from clinical trial data. One-way, scenario, and probabilistic sensitivity analyses were performed. RESULTS: In a cohort of 1000 patients, adding an SGLT2 inhibitor led to $3.9 million more in spending and 93 more patients reaching goal A1C compared with switching from a DPP-4 inhibitor to a GLP-1 RA. This resulted in an incremental cost-effectiveness ratio (ICER) of $42,125 per patient to achieve goal A1C from the private payer perspective. Using a public payer perspective led to an ICER of $103,829. These results were most sensitive to changes in drug costs and the proportion of patients achieving A1C goal or discontinuing. CONCLUSIONS: Assuming a $50,000 willingness-to-pay threshold, adding an SGLT2 inhibitor was cost-effective compared with switching from a DPP-4 inhibitor to a GLP-1 RA from a private payer perspective but not from a public payer perspective. This study highlights how differences in payer reimbursement rates for medications can lead to contrasting results.

Duke Scholars

Published In

Am J Manag Care

DOI

EISSN

1936-2692

Publication Date

March 1, 2020

Volume

26

Issue

3

Start / End Page

e76 / e83

Location

United States

Related Subject Headings

  • United States
  • Sodium-Glucose Transporter 2 Inhibitors
  • Metformin
  • Hypoglycemic Agents
  • Humans
  • Health Services
  • Health Policy & Services
  • Glycated Hemoglobin
  • Drug Therapy, Combination
  • Dipeptidyl-Peptidase IV Inhibitors
 

Citation

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Hung, A., Jois, B., Lugo, A., & Slejko, J. F. (2020). Cost-effectiveness of diabetes treatment sequences to inform step therapy policies. Am J Manag Care, 26(3), e76–e83. https://doi.org/10.37765/ajmc.2020.42639
Hung, Anna, Bhavna Jois, Amy Lugo, and Julia F. Slejko. “Cost-effectiveness of diabetes treatment sequences to inform step therapy policies.Am J Manag Care 26, no. 3 (March 1, 2020): e76–83. https://doi.org/10.37765/ajmc.2020.42639.
Hung A, Jois B, Lugo A, Slejko JF. Cost-effectiveness of diabetes treatment sequences to inform step therapy policies. Am J Manag Care. 2020 Mar 1;26(3):e76–83.
Hung, Anna, et al. “Cost-effectiveness of diabetes treatment sequences to inform step therapy policies.Am J Manag Care, vol. 26, no. 3, Mar. 2020, pp. e76–83. Pubmed, doi:10.37765/ajmc.2020.42639.
Hung A, Jois B, Lugo A, Slejko JF. Cost-effectiveness of diabetes treatment sequences to inform step therapy policies. Am J Manag Care. 2020 Mar 1;26(3):e76–e83.

Published In

Am J Manag Care

DOI

EISSN

1936-2692

Publication Date

March 1, 2020

Volume

26

Issue

3

Start / End Page

e76 / e83

Location

United States

Related Subject Headings

  • United States
  • Sodium-Glucose Transporter 2 Inhibitors
  • Metformin
  • Hypoglycemic Agents
  • Humans
  • Health Services
  • Health Policy & Services
  • Glycated Hemoglobin
  • Drug Therapy, Combination
  • Dipeptidyl-Peptidase IV Inhibitors