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Cost-effectiveness analysis
Compared with glyburide, sitagliptin associated with incremental cost-effectiveness ratio of $169 572 per QALY and exenatide with $278 935 per QALY as second-line treatment in adult diabetics in the USA
  1. Wendy A Davis
  1. Correspondence to Wendy A Davis
    University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, PO Box 480, Fremantle WA 6959, Australia; wdavis{at}

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Commentary on:

Diabetes mellitus is increasingly prevalent and costly worldwide. New antihyperglycaemic therapies are more expensive than older generic ones. Payers need evidence that the additional benefits outweigh the higher costs. Antihyperglycaemic treatment strategies affect disease progression through reductions in HbA1c and effects on cardiovascular risk factors such as hypertension, dyslipidaemia and weight gain. Side effects associated with treatments, such as hypoglycaemia and oedema, also influence costs and quality of life.

The modelling

The cost-effectiveness analyses by Sinha and colleagues compared diabetes treatment modalities in patients with new-onset diabetes. With metformin as first-line therapy, glyburide, exenatide and sitagliptin were compared as second-line therapy. Rosiglitazone and NPH insulin were then added as required to control glycaemia. Costs (presented in 2008 US dollars) associated with a diagnosis of diabetes between the ages of 25 and 65 years until death or age 95 were measured from the perspective of the US healthcare system. Outcome …

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  • Competing interests WAD has received unrestricted funding from Eli Lilly Australia to investigate the economic impact of weight change among patients with type 2 diabetes treated with antidiabetic agents.