IMPROVEMENT IN CARDIOVASCULAR RISK FACTORS AND LONG-TERM
OUTCOMES IN PEOPLE WITH T2D TREATED WITH LIRAGLUTIDE OR
GLIMEPIRIDE MONOTHERAPY [2308-PO]
Sullivan SD, Alfonso-Cristancho R, Conner C, Hammer M, Blonde L; Seattle, WA,
Princeton, NJ; Bagsvaerd, Denmark; New Orleans, LA
Type 2 diabetes is associated with a substantial lifetime risk of cardiovascular
complications. Computer models and simulations are important in understanding the
impact of diabetes because they can provide information that is not available from
randomized-controlled trials, such as estimates of long-term outcomes or expected event
rates in specific patient subpopulations.1 Pharmacoeconomic modeling is also an
important part of the formulary review process for new treatments.2 In this study,
Sullivan et al used data from a 12-month randomized clinical trial that compared the
incretin analogue liraglutide with glimepiride to simulate rates of cardiovascular disease
over 30 years for patients using these 2 treatments. These data were applied to a diabetes
model developed by the Center for Outcomes Research (the CORE diabetes model),
which uses epidemiologic data from long-term studies to extrapolate morbidity,
mortality, and treatment costs on the basis of the patients’ baseline demographic and
clinical characteristics. Event rates were estimated for the liraglutide and glimepiride
treatment groups for several clinical outcomes, including cardiovascular events, renal and
ocular disease, and healthcare costs. The investigators estimated that the 30-year survival
rate with liraglutide would be approximately double that of glimepiride (16.5%, 13.6%,
and 7.3% for the liraglutide 1.8-mg, liraglutide 1.2-mg, and glimepiride groups,
respectively). Expected numbers of several other outcomes were also significantly lower
after 30 years with liraglutide, including nonfatal renal and ocular events, and neuropathy
requiring amputation. In addition, the investigators estimated that the cumulative cost of
treatment over 30 years would be higher for glimepiride-treated patients by an average of
$9367. Overall, the investigators concluded that long-term treatment with liraglutide would be expected to produce greater survival and fewer complications of diabetes than
glimepiride, with lower total treatment cost.
The CORE diabetes model used in this study has also been used to estimate long-term
outcomes with other combinations of treatment for type 2 diabetes. In one study, the
model was used to demonstrate the long-term cost effectiveness of metformin in
combination with the incretin agonist exenatide versus metformin plus generic glyburide,
pioglitazone, insulin glargine, or no additional treatment.2 These authors noted that
although payers are generally interested in short-term economic analyses, treatment with
exenatide in this model became more cost effective over time due to the avoidance of
diabetes-related complications that become increasingly apparent after several years. A
more recent study modeled 30-year outcomes in patients treated with 1 of 2 liraglutide
doses (1.2 or 1.8 mg) or rosiglitazone, in combination with glimepiride as background
therapy.3 Estimated survival rates were higher after 30 years with liraglutide 1.2 mg
(15%) and liraglutide 1.8 mg (16%) than with rosiglitazone (12.6%). Liraglutide was
projected to result in lower rates of cardiovascular, renal, and ocular events, as well as
lower overall treatment costs. Rosiglitazone was projected to result in fewer amputations,
possibly due to the shorter survival time of these patients. The results of modeling studies
such as these suggest that newer treatment options have the potential to improve long-term
outcomes and lower total treatment costs in patients with type 2 diabetes.
References
1. American Diabetes Association Consensus Panel. Guidelines for computer modeling
of diabetes and its complications. Diabetes Care. 2004;27:2262-2265.
2. Watkins JB, Minshall ME, Sullivan SD. Application of economic analyses in U.S.
managed care formulary decisions: a private payer’s experience. J Manag Care Pharm.
2006;12:726-735.
3. Sullivan SD, Alfonso-Cristancho R, Conner C, et al. Long-term outcomes in patients
with type 2 diabetes receiving glimepiride combined with liraglutide or rosiglitazone.
Cardiovasc Diabetol. 2009;8:12.
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