A short-term cost-of-treatment model for type 2 diabetes: Comparison of glipizide gastrointestinal therapeutic system, metformin, and acarbose

Objective: To compare, from a managed care perspective, the 3-year costs of 3 first-line monotherapy strategies in type 2 diabetes patients: glipizide gastrointestinal therapeutic system (GITS), metformin, and acarbose. Study Design: A Markov model, with a Monte Carlo simulation, was developed to compare the costs to achieve full glycemic control (hemoglobin A,, of le ss than or equal to 7%) with each first-line strategy. Patients and Methods: The patient population for the model was assumed to b e all newly diagnosed type 2 diabetes patients eligible for monotherapy wit h an oral agent. Each monotherapy could be succeeded by add-on treatments. The model included the costs of routine medical care and supplies, medicati on, adverse events, and treatment failures. Results: Using a Monte Carlo simulation, the mean 3-year cumulative costs p er patient were $4971, $5273; and $5311 for glipizide metformin, and acarbo se first-line strategies, respectively. The main cost drivers were drug pri ces. Mean 3-year cost savings for first-line glipizide GITS were $301 over metformin and $340 over acarbose. Between 83% and 85% of all simulations sh owed cost savings with glipizide GITS compared with the other agents. Conclusions: The model suggests first-line monotherapy with glipizide GITS should result in desirable short-term economic benefits for managed care. B ecause the model incorporates recommended glycemic goals and performed well in sensitivity analyses, if should be applicable to a variety of clinical practices and useful for economic assessments of new therapies. Results of this model should be verified prospectively in typical care settings.