Applying some UK Prospective Diabetes Study results to Switzerland: the cost-effectiveness of intensive glycaemic control with metformin versus conventional control in overweight patients with type-2 diabetes

Objective: The results of the metformin sub-study of the United Kingdom Pro spective Diabetes Study (UKPDS) were applied through modelling techniques t o the Swiss setting, allowing a cost-effectiveness analysis of the manageme nt of overweight type-2 diabetes patients with either conventional glycaemi c control or intensive control with metformin from the Swiss third-party pa yer perspective. Methods: Occurrence of diabetes-related complications was simulated using a Markov model. Probabilities for complications were taken from the UKPDS, a nd costs were retrieved from published sources. Total direct costs (costs o f diabetes therapy plus costs of treating complications) and survival over an Ii-year period were determined for cohorts randomised to either conventi onal glycaemic control or intensive control with metformin. Changes in life expectancy were calculated for conventional versus intensive control with metformin. Extensive sensitivity analysis was performed. Results: Mean costs per patient over the 11-year follow-up period (discount ed at 5% per annum) were CMF 10 877 and CHF 9950 for patients randomised to either conventional control or intensive control with metformin respective ly. Intensive control with metformin led to improved survival (0.43 life-ye ars gained per patient) over the Ii-year period. Outcomes were most sensiti ve to variations in the acquisition costs of metformin. Changes in the even t rates and costs related to myocardial infarction, renal failure, and stro ke also had important impacts. Conclusions: Within the limitations of the modelling study, intensive glyca emic control with metformin was cost- and life-saving in overweight type-2 diabetes patients in the Swiss setting.