Cost-utility analysis of liraglutide compared with sulphonylurea or sitagliptin, all as add-on to metformin monotherapy in Type 2 diabetes mellitus

Aim To investigate the cost-effectiveness of liraglutide as add-on to metformin vs. glimepiride or sitagliptin in patients with Type 2 diabetes uncontrolled with first-line metformin. Methods Data were sourced from a clinical trial comparing liraglutide vs. glimepiride, both in combination with metformin, and a clinical trial comparing liraglutide vs. sitagliptin, both as add-on to metformin. Only the subgroup of patients in whom liraglutide was added to metformin monotherapy was included in the costutility analysis. The CORE Diabetes Model was used to simulate outcomes and costs with liraglutide 1.2 and 1.8 mg vs. glimepiride and vs. sitagliptin over patients lifetimes. Treatment effects were taken directly from the trials. Costs and outcomes were discounted at 3.5% per annum and costs were accounted from a third-party payer (UK National Health System) perspective. Results Treatment with liraglutide 1.2 and 1.8 mg resulted, respectively, in mean increases in quality-adjusted life expectancy of 0.32 +/- 0.15 and 0.28 +/- 0.14 quality-adjusted life years vs. glimepiride, and 0.19 +/- 0.15 and 0.31 +/- 0.15 quality-adjusted life years vs. sitagliptin, and was associated with higher costs of 3003 pound +/- 678 pound and 4688 pound +/- 639 pound vs. glimepiride, and 1842 pound +/- 751 pound and 3224 pound +/- 683 pound vs. sitagliptin, over a patients lifetime. Both liraglutide doses were cost-effective, with incremental cost-effectiveness ratios of 9449 pound and 16 pound 501 per quality-adjusted life year gained vs. glimepiride, and 9851 pound and 10 pound 465 per quality-adjusted life year gained vs. sitagliptin, respectively. Conclusions Liraglutide, added to metformin monotherapy, is a cost-effective option for the treatment of Type 2 diabetes in a UK setting.