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Lifetime cost-effectiveness simulation of once-weekly exenatide in type 2 diabetes: A cost-utility analysis based on the EXSCEL trial.

Publication ,  Journal Article
Becker, F; Dakin, HA; Reed, SD; Li, Y; Leal, J; Gustavson, SM; Wittbrodt, E; Hernandez, AF; Gray, AM; Holman, RR
Published in: Diabetes Res Clin Pract
January 2022

AIMS: The Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial assessed once-weekly exenatide (EQW) vs. placebo, added to usual care in 14,752 patients with type 2 diabetes mellitus (Clinicaltrials.gov: NCT01144338). We assessed the lifetime cost-effectiveness of adding EQW vs. usual care alone from a healthcare perspective. METHODS: Medical resource use and EQ-5D utilities were collected throughout the study. Within-trial results were extrapolated to a lifetime horizon using the UK Prospective Diabetes Study Outcomes Model version 2 (UKPDS-OM2), predicting predict cardiovascular and microvascular events. Cost-effectiveness was evaluated separately for US and UK settings, with outcomes measured in quality-adjusted life-years (QALYs). RESULTS: EQW plus usual care gained 0.162 QALYs at an additional cost of $41,545/patient, compared with usual care in a US setting. The incremental cost-effectiveness ratio (ICER) was $259,223/QALY. In a UK setting, the QALY gain was 0.151 at an additional cost of £6357: an ICER of £42,589/QALY. Sensitivity analyses ranged between $34,369-$269,571 and £3430-£46,560 per QALY gained. CONCLUSIONS: In a lifetime extrapolation, adding EQW to usual care increased QALYs and costs compared with usual care alone. The base-case ICERs exceeded the commonly-cited cost-effectiveness thresholds of $100,000/QALY and £20,000/QALY. However, ICERs were considerably lower in some subgroups, and in sensitivity analyses.

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Published In

Diabetes Res Clin Pract

DOI

EISSN

1872-8227

Publication Date

January 2022

Volume

183

Start / End Page

109152

Location

Ireland

Related Subject Headings

  • Quality-Adjusted Life Years
  • Prospective Studies
  • Hypoglycemic Agents
  • Humans
  • Exenatide
  • Endocrinology & Metabolism
  • Diabetes Mellitus, Type 2
  • Cost-Benefit Analysis
  • 5203 Clinical and health psychology
  • 4206 Public health
 

Citation

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Becker, F., Dakin, H. A., Reed, S. D., Li, Y., Leal, J., Gustavson, S. M., … Holman, R. R. (2022). Lifetime cost-effectiveness simulation of once-weekly exenatide in type 2 diabetes: A cost-utility analysis based on the EXSCEL trial. Diabetes Res Clin Pract, 183, 109152. https://doi.org/10.1016/j.diabres.2021.109152
Becker, Frauke, Helen A. Dakin, Shelby D. Reed, Yanhong Li, José Leal, Stephanie M. Gustavson, Eric Wittbrodt, Adrian F. Hernandez, Alastair M. Gray, and Rury R. Holman. “Lifetime cost-effectiveness simulation of once-weekly exenatide in type 2 diabetes: A cost-utility analysis based on the EXSCEL trial.Diabetes Res Clin Pract 183 (January 2022): 109152. https://doi.org/10.1016/j.diabres.2021.109152.
Becker F, Dakin HA, Reed SD, Li Y, Leal J, Gustavson SM, et al. Lifetime cost-effectiveness simulation of once-weekly exenatide in type 2 diabetes: A cost-utility analysis based on the EXSCEL trial. Diabetes Res Clin Pract. 2022 Jan;183:109152.
Becker, Frauke, et al. “Lifetime cost-effectiveness simulation of once-weekly exenatide in type 2 diabetes: A cost-utility analysis based on the EXSCEL trial.Diabetes Res Clin Pract, vol. 183, Jan. 2022, p. 109152. Pubmed, doi:10.1016/j.diabres.2021.109152.
Becker F, Dakin HA, Reed SD, Li Y, Leal J, Gustavson SM, Wittbrodt E, Hernandez AF, Gray AM, Holman RR. Lifetime cost-effectiveness simulation of once-weekly exenatide in type 2 diabetes: A cost-utility analysis based on the EXSCEL trial. Diabetes Res Clin Pract. 2022 Jan;183:109152.
Journal cover image

Published In

Diabetes Res Clin Pract

DOI

EISSN

1872-8227

Publication Date

January 2022

Volume

183

Start / End Page

109152

Location

Ireland

Related Subject Headings

  • Quality-Adjusted Life Years
  • Prospective Studies
  • Hypoglycemic Agents
  • Humans
  • Exenatide
  • Endocrinology & Metabolism
  • Diabetes Mellitus, Type 2
  • Cost-Benefit Analysis
  • 5203 Clinical and health psychology
  • 4206 Public health