Cost-effectiveness analysis of combined therapy of type 2 diabetes mellitus in ukraine

Abstract

Type 2 diabetes mellitus (T2DM) gets the status non-infectious epidemic. T2DM needs effective and economically justified therapy in the limited financing of healthcare. Aims: scientific justification for the choice of schemes of combined therapy of type 2 diabetes mellitus. Objects: 1) retrospective analysis of 1792 inpatient’s medical histories of the patients with T2DM; these patients were treated at the endocrinology clinics of Podolsky region of Ukraine in 2011-2013; 2) frequency analysis; 3) ATC/DDD-methodology; 4) cost-effectiveness analysis; 5) sensitivity analysis. Cost of DDD was calculated according to information from the State Register of 12.06.2014 on the basis of national pricing. Results of research. Frequency analysis showed that the combined therapy with metformin + sulfonylurea was used in 66% of cases: metformin + glimepiride – in 45% of cases, metformin + gliclazide – in 14.5%, metformin + glibenclamide – in 6.1%. ATC/DDD-methodology showed that the cost for DDD of combination metformin + glimepiride was in the range from 2.70 to 8.88 UAH, metformin + gliclazide – 3.29-9.43 UAH, metformin + glibenclamide – 1.98-6.20 UAH. Cost-effectiveness analysis showed that the cost of unit of effectiveness for metformin + glibenclamide was in the range from 40.33 to 126.27 UAH, metformin + glimepiride – from 53.68 to 176.51 UAH, metformin + gliclazide – from 55.69 to 159.63 UAH, in the context of minimal and maximal prices of generics. The sensitivity analysis showed that the scheme of metformin + glibenclamide keeps pharmacoeconomic advantages to increased cost of DDD up to 17% in comparison with scheme metformin + gliclazide and to 15% in comparison with scheme metformin + glimepirid. Conclusions. 1) Frequency analysis found that a combined therapy was used in 66% of cases; 2) ATC/DDD-methodology showed that the cost of DDD of investigated combined therapy was in the range from 1.98 to 9.43 UAH, in the context of minimal and maximal costs of generics of oral hypoglycemic drugs; 3) Cost-effectiveness analysis showed that the cost of unit of effectiveness for metformin + glibenclamide was in the range from 40.33 to 126.27 UAH, metformin + glimepiride – from 53.68 to 176.51 UAH, metformin + gliclazide – from 55.69 to 159.63 UAH; 4) The sensitivity analysis showed the stability of the results of the pharmacoeconomic study.