Cost-effectiveness of pioglitazone in type 2 diabetes patients with a history of macrovascular disease: a German perspective
<p>Abstract</p> <p>Background</p> <p>The aim of this study was to project health-economic outcomes relevant to the German setting for the addition of pioglitazone to existing treatment regimens in patients with type 2 diabetes, evidence of macrovascular disease and at h...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2009-05-01
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| Series: | Cost Effectiveness and Resource Allocation |
| Online Access: | http://www.resource-allocation.com/content/7/1/9 |
| _version_ | 1818790893830799360 |
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| author | Massi-Benedetti Massimo Erny-Albrecht Katrina M Goodall Gordon Scherbaum Werner A Erdmann Erland Valentine William J |
| author_facet | Massi-Benedetti Massimo Erny-Albrecht Katrina M Goodall Gordon Scherbaum Werner A Erdmann Erland Valentine William J |
| author_sort | Massi-Benedetti Massimo |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>The aim of this study was to project health-economic outcomes relevant to the German setting for the addition of pioglitazone to existing treatment regimens in patients with type 2 diabetes, evidence of macrovascular disease and at high risk of cardiovascular events.</p> <p>Methods</p> <p>Event rates corresponding to macrovascular outcomes from the Prospective Pioglitazone Clinical Trial in Macrovascular Events (PROactive) study of pioglitazone were used with a modified version of the CORE Diabetes Model to simulate outcomes over a 35-year time horizon. Direct medical costs were accounted from a healthcare payer perspective in year 2005 values. Germany specific costs were applied for patient treatment, hospitalization and management. Both costs and clinical benefits were discounted at 5.0% <it>per annum</it>.</p> <p>Results</p> <p>Over patient lifetimes pioglitazone treatment improved undiscounted life expectancy by 0.406 years and improved quality-adjusted life expectancy by 0.120 quality-adjusted life years (QALYs) compared to placebo. Direct medical costs (treatment plus complication costs) were marginally higher for pioglitazone treatment and calculation of the incremental cost-effectiveness ratio (ICER) produced a value of €13,294 per QALY gained with the pioglitazone regimen versus placebo. Acceptability curve analysis showed that there was a 78.2% likelihood that pioglitazone would be considered cost-effective in Germany, using a "good value for money" threshold of €50,000 per QALY gained. Sensitivity analyses showed that the results were most sensitive to changes in the simulation time horizon. After adjustment for the potential stabilization of pancreatic β-cell function with pioglitazone treatment, the ICER was €6,667 per QALY gained for pioglitazone versus placebo.</p> <p>Conclusion</p> <p>The findings of this modelling analysis indicated that, for patients with a history of macrovascular disease, addition of pioglitazone to existing therapy reduces the long-term cumulative incidence of diabetes-complications at a cost that would be considered to represent good value for money in the German setting.</p> |
| first_indexed | 2024-12-18T15:02:42Z |
| format | Article |
| id | doaj.art-f6a24f3cbf244fb0aaab273b60b4b68c |
| institution | Directory Open Access Journal |
| issn | 1478-7547 |
| language | English |
| last_indexed | 2024-12-18T15:02:42Z |
| publishDate | 2009-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Cost Effectiveness and Resource Allocation |
| spelling | doaj.art-f6a24f3cbf244fb0aaab273b60b4b68c2022-12-21T21:03:52ZengBMCCost Effectiveness and Resource Allocation1478-75472009-05-0171910.1186/1478-7547-7-9Cost-effectiveness of pioglitazone in type 2 diabetes patients with a history of macrovascular disease: a German perspectiveMassi-Benedetti MassimoErny-Albrecht Katrina MGoodall GordonScherbaum Werner AErdmann ErlandValentine William J<p>Abstract</p> <p>Background</p> <p>The aim of this study was to project health-economic outcomes relevant to the German setting for the addition of pioglitazone to existing treatment regimens in patients with type 2 diabetes, evidence of macrovascular disease and at high risk of cardiovascular events.</p> <p>Methods</p> <p>Event rates corresponding to macrovascular outcomes from the Prospective Pioglitazone Clinical Trial in Macrovascular Events (PROactive) study of pioglitazone were used with a modified version of the CORE Diabetes Model to simulate outcomes over a 35-year time horizon. Direct medical costs were accounted from a healthcare payer perspective in year 2005 values. Germany specific costs were applied for patient treatment, hospitalization and management. Both costs and clinical benefits were discounted at 5.0% <it>per annum</it>.</p> <p>Results</p> <p>Over patient lifetimes pioglitazone treatment improved undiscounted life expectancy by 0.406 years and improved quality-adjusted life expectancy by 0.120 quality-adjusted life years (QALYs) compared to placebo. Direct medical costs (treatment plus complication costs) were marginally higher for pioglitazone treatment and calculation of the incremental cost-effectiveness ratio (ICER) produced a value of €13,294 per QALY gained with the pioglitazone regimen versus placebo. Acceptability curve analysis showed that there was a 78.2% likelihood that pioglitazone would be considered cost-effective in Germany, using a "good value for money" threshold of €50,000 per QALY gained. Sensitivity analyses showed that the results were most sensitive to changes in the simulation time horizon. After adjustment for the potential stabilization of pancreatic β-cell function with pioglitazone treatment, the ICER was €6,667 per QALY gained for pioglitazone versus placebo.</p> <p>Conclusion</p> <p>The findings of this modelling analysis indicated that, for patients with a history of macrovascular disease, addition of pioglitazone to existing therapy reduces the long-term cumulative incidence of diabetes-complications at a cost that would be considered to represent good value for money in the German setting.</p>http://www.resource-allocation.com/content/7/1/9 |
| spellingShingle | Massi-Benedetti Massimo Erny-Albrecht Katrina M Goodall Gordon Scherbaum Werner A Erdmann Erland Valentine William J Cost-effectiveness of pioglitazone in type 2 diabetes patients with a history of macrovascular disease: a German perspective Cost Effectiveness and Resource Allocation |
| title | Cost-effectiveness of pioglitazone in type 2 diabetes patients with a history of macrovascular disease: a German perspective |
| title_full | Cost-effectiveness of pioglitazone in type 2 diabetes patients with a history of macrovascular disease: a German perspective |
| title_fullStr | Cost-effectiveness of pioglitazone in type 2 diabetes patients with a history of macrovascular disease: a German perspective |
| title_full_unstemmed | Cost-effectiveness of pioglitazone in type 2 diabetes patients with a history of macrovascular disease: a German perspective |
| title_short | Cost-effectiveness of pioglitazone in type 2 diabetes patients with a history of macrovascular disease: a German perspective |
| title_sort | cost effectiveness of pioglitazone in type 2 diabetes patients with a history of macrovascular disease a german perspective |
| url | http://www.resource-allocation.com/content/7/1/9 |
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