Real-World Clinical Effectiveness and Cost Savings of Liraglutide Versus Sitagliptin in Treating Type 2 Diabetes for 1 and 2 Years

Diabetes Therapy, May 2018

Introduction This study compared the clinical and economic outcomes of long-term use of liraglutide versus sitagliptin for the treatment of type 2 diabetes (T2DM) in real-world practice in the USA. Methods We identified adult patients (≥ 18 years old) with T2DM who initiated liraglutide or sitagliptin in 2010–2014 using a large claims database. Quarterly glycemic control measures and annual healthcare costs were assessed during the 1st and 2nd years of persistent medication use. Their associations with medication use (liraglutide or sitagliptin) were estimated using multivariable regression models adjusted for patient demographic and clinical characteristics. Results A total of 3113 patients persistently used liraglutide (N = 493) or sitagliptin (N = 2620) for ≥ 1 year [mean age (standard deviation, SD): 53 (8.5) vs. 56 (9.7) years; 48.3% vs. 62.3% males; both p < 0.05]; 911 (including 113 liraglutide users) were persistent users for ≥ 2 years. During the 1st-year follow-up, liraglutide users (versus sitagliptin users, after adjustment) experienced larger glycated hemoglobin (HbA1c) reductions from baseline (ranging from 0.34%-point in quarter 1 to 0.21%-point in quarter 4); higher likelihoods of obtaining HbA1c reductions of ≥ 1%-points or ≥ 2%-points [odds ratios (ORs) range 1.47–2.04]; and higher likelihoods of reaching HbA1c goals of < 6.5% or < 7% (ORs range 1.51–2.12) (all p < 0.05). Liraglutide users also experienced HbA1c reductions from baseline in the 2nd-year follow-up (0.53–0.33%-point, all p < 0.05). Although liraglutide users incurred higher healthcare costs than sitagliptin users during the 1st-year follow-up, they had $2674 (per patient) lower all-cause medical costs (adjusted cost ratio: 0.67, p < 0.05) and similar total costs (all-cause and diabetes-related) in the 2nd year. Conclusion Long-term use of liraglutide for 1 or 2 years was associated with better glycemic control than using sitagliptin. Savings in medical costs were realized for liraglutide users during the 2nd year of persistent treatment, which offset differences in pharmacy costs. Funding Novo Nordisk Inc.

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Real-World Clinical Effectiveness and Cost Savings of Liraglutide Versus Sitagliptin in Treating Type 2 Diabetes for 1 and 2 Years

Real-World Clinical Effectiveness and Cost Savings of Liraglutide Versus Sitagliptin in Treating Type 2 Diabetes for 1 and 2 Years Qian Li 0 1 . Rahul Ganguly . Michael L. Ganz . Cory Gamble . 0 1 Tam Dang-Tan 0 1 0 R. Ganguly C. Gamble T. Dang-Tan Novo Nordisk Inc , 800 Scudders Mill Road, Plainsboro, NJ 08536 , USA 1 Q. Li (&) M. L. Ganz Evidera , 500 Totten Pond Road, 5th Floor, Waltham, MA 02451 , USA Introduction: This study compared the clinical and economic outcomes of long-term use of liraglutide versus sitagliptin for the treatment of type 2 diabetes (T2DM) in real-world practice in the USA. Methods: We identified adult patients (C 18 years old) with T2DM who initiated liraglutide or sitagliptin in 2010-2014 using a large claims database. Quarterly glycemic control measures and annual healthcare costs were assessed during the 1st and 2nd years of persistent medication use. Their associations with medication use (liraglutide or sitagliptin) were estimated using multivariable regression models adjusted for patient demographic and clinical characteristics. - Results: A total of 3113 patients persistently used liraglutide (N = 493) or sitagliptin (N = 2620) for C 1 year [mean age (standard deviation, SD): 53 (8.5) vs. 56 (9.7) years; 48.3% vs. 62.3% males; both p \ 0.05]; 911 (including 113 liraglutide users) were persistent users for C 2 years. During the 1st-year follow-up, liraglutide users (versus sitagliptin users, after adjustment) experienced larger glycated hemoglobin (HbA1c) reductions from baseline (ranging from 0.34%-point in quarter 1 to 0.21%point in quarter 4); higher likelihoods of obtaining HbA1c reductions of C 1%-points or C 2%-points [odds ratios (ORs) range 1.47–2.04]; and higher likelihoods of reaching HbA1c goals of \ 6.5% or \ 7% (ORs range 1.51–2.12) (all p \ 0.05). Liraglutide users also experienced HbA1c reductions from baseline in the 2nd-year follow-up (0.53–0.33%-point, all p \ 0.05). Although liraglutide users incurred higher healthcare costs than sitagliptin users during the 1st-year follow-up, they had $2674 (per patient) lower all-cause medical costs (adjusted cost ratio: 0.67, p \ 0.05) and similar total costs (all-cause and diabetes-related) in the 2nd year. Conclusion: Long-term use of liraglutide for 1 or 2 years was associated with better glycemic control than using sitagliptin. Savings in medical costs were realized for liraglutide users during the 2nd year of persistent treatment, which offset differences in pharmacy costs. Funding: Novo Nordisk Inc. INTRODUCTION Diabetes is an emerging global epidemic—this chronic metabolic condition affected 1 in every 11 adults worldwide in 2017 and 9.4% of the US population in 2015 [ 1, 2 ]. Diabetes can lead to many micro- and macrovascular complications [3] and accounted for 10.7% of global all-cause mortality among people 20–79 years old [ 2 ]. Diabetes was estimated to cost $727 billion (US dollars; USD) in 2017, responsible for 6–16.6% of total healthcare expenditures worldwide [ 2 ]. About half of the global diabetes budget is spent in the US, where patients with diagnosed diabetes on average spend about $13700 on medical services annually, which is about 2.3 times higher than that spent by people without diabetes [1]. Type 2 diabetes mellitus (T2DM), characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency, accounts for approximately 90% of all diabetes cases [4]. Due to the progressive nature of diabetes, the initiation of pharmacologic agents is recommended at the time of diagnosis of T2DM, along with lifestyle modifications such as diet and exercise to achieve glycemic control [ 5–7 ]. With metformin as the preferred 1st-line therapy, additional anti-diabetic drugs are often considered and, as recommended by the American Diabetes Association (ADA), patient’s history of atherosclerotic cardiovascular (CV) disease plays a key role in the selection of the add-on therapy [5]. Liraglutide, which belongs to the class of glucagon-like peptide-1 (GLP-1) receptor agonists, is a commonly used anti-diabetic therapy. It was shown to reduce the risk of major adverse CV events in a recent clinical trial [8], and it is currently the only agent in its class that has been approved to reduce the risk of major adverse cardiovascular events (cardiovascular death, nonfatal MI or nonfatal stroke) in adults with T2DM and established cardiovascular disease [5]. The efficacy and safety of liraglutide for the treatment of T2DM has been extensively studied in clinical trials. Liraglutide demonstrated superior glycemic control, greater weight loss, and better treatment satisfaction after 52 weeks as an add-on to metformin compared with another incretin-based therapy, sitagliptin [a dipeptidyl peptidase-4 (DPP-4) inhibitor] [9]. The findings were consistent with those observed at a shorter follow-up period [ 10–12 ], while gastrointestinal problems were common adverse reactio (...truncated)


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Qian Li, Rahul Ganguly, Michael L. Ganz, Cory Gamble, Tam Dang-Tan. Real-World Clinical Effectiveness and Cost Savings of Liraglutide Versus Sitagliptin in Treating Type 2 Diabetes for 1 and 2 Years, Diabetes Therapy, 2018, pp. 1-15, DOI: 10.1007/s13300-018-0432-2