EVALUATION OF THE POTENTIAL CLINICAL AND ECONOMIC-EFFECTS OF BODYWEIGHT STABILIZATION WITH ACARBOSE IN PATIENTS WITH TYPE-2 DIABETES-MELLITUS - A DECISION-ANALYTICAL APPROACH

Bodyweight is an acknowledged independent risk factor for coronary hea rt disease (CHD). The present model analysis was undertaken to investi gate the clinical and economic impact of bodyweight gain in patients w ith type 2 (noninsulin-dependent) diabetes mellitus and its effects on the development of CHD. Based on a retrospective re-evaluation of dat a from the Diabetes Intervention Study (DIS), patients with type 2 dia betes mellitus and stable bodyweight (group A) had a significantly low er rate of combined CHD events (30.3%) than patients showing a bodywei ght gain (group B; 38.2%) over 10 years. Prevention of body weight gai n, therefore, appears to be a meaningful strategy in the management of diabetes mellitus. In addition to this clinical advantage, prevention of CHD will also result in economic savings associated with avoided t reatment of coronary events. Based on the clinical outcomes from the D IS, the calculated per-patient net savings for a patient with type 2 d iabetes mellitus and stable bodyweight amounted to 1085 deutschemarks (DM) when compared with a patient experiencing a bodyweight increase. In a further step, the above situation was projected to current type 2 diabetes mellitus practice. Oral first-line treatment of type 2 diabe tes mellitus is usually initiated with glibenclamide (glyburide), whic h is known to increase bodyweight (reflecting group B). The novel alph a-glucosidase inhibitor acarbose, in contrast, appears to be as effect ive as glibenclamide, but has the advantage of being bodyweight-neutra l (reflecting group A). From the clinical viewpoint, acarbose can thus be considered an alternative to glibenclamide. From the viewpoint of drug costs, monotherapy with acarbose is 4 times as expensive as glibe nclamide in Germany, resulting in per-patient incremental costs of DM3 527 for acarbose over 10 years. Balanced against the potential 10-year cost saving of DM1085 resulting from the potential of acarbose to pre vent CHD, around one-third of the incremental cost of acarbose may be recouped by this single effect. However, further possible benefits of acarbose, including the avoidance of hypoglycaemia and the deferral of costly insulin therapy, may improve the economic value of this novel antidiabetic agent. Given the indirect approach of this evaluation and its many limitations, the above findings need critical appraisal, and comparative trials are urgently required to substantiate our prelimin ary results.