Short-term costs versus long-term gains: The trade-off for glitazone therapy

Diabetes is a common condition-that is expensive to treat and is associated with substantial morbidity and mortality. The thiazolidinediones (glitazon es) are a new class of drugs that work as insulin sensitizers when they are used alone or in combination with other glucose-lower-agents. In short-ter m trials, the glitazones have been shown-to improve glycemic control, raise serum high-density lipoprotein cholesterol, and increase serum low-density lipoprotein cholesterol;the impact on serum triglycerides varies with the agent. Because the glitazones are much more costly than other oral glucose- lowering agents, clinicians and decision makers must carefully weigh their potential long-term benefits against the-short-term costs: of care. Therapi es such as the glitazones that have a high initial cost can be cost effecti ve if they reduce disease-related end points (and their attendant expense) to a greater extent than the alternative. Because the glitazones do not app ear offer an incremental benefit in terms of short-term glucose control, th e hypothesized benefits of these agents on longterm glycemic control and ca rdiovascular disease are likely to be critical factors influencing the cost effectiveness of these drugs relative to other agents. Prior to the availa bility of such data, the cost effectiveness of the glitazones ver sus other agents as initial or secondary therapy is highly speculative.