PHARMACOECONOMIC ANALYSIS OF VILDAGLIPTIN VS GLIMEPIRIDE AS ADD-ON TO METFORMIN IN THE MANAGEMENT OF TYPE 2 DIABETES AT UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL, NIGERIA
Alagala M. B.* and Williams E. S.
ABSTRACT
Background: Type 2 diabetes is a chronic metabolic disease that has been identified as a global public health challenge. The cost of controlling glycemic levels with antidiabetic agents is increasing, and there is a need in clinical practice to consider the cost of achieving a target glycemic level. Aim: To compare the cost-effectiveness of vildagliptin-metformin vs glimepiride-metformin combination therapies for patients who were inadequately controlled with metformin. Materials and method: A retrospective study design using a descriptive approach was adopted to determine the cost effectiveness of the two drug combinations for achieving adequate glycemic control. Data were extracted from the patients’ folders using a distinctive data collection form and were used to estimate the cost and extent of glycemic control achieved by the two treatment therapies. Cost effectiveness analysis was done by calculating the expense incurred on 1mmol/L reduction in fasting blood glucose levels after 3 years of therapy and was used to calculate the average cost effectiveness ratio (ACER) and Incremental cost effectiveness ratio (ICER). Data were analyzed using the Statistical Package for Social Science (SPSS) version 28.0 and Microsoft Excel. Results: A total of 203 patients were included in the study, out of which 63.1% were females and 36.9% were males. The mean FBG for glimepiride-metformin before the therapy was greater than the mean fasting blood glucose (FBG) after treatment (9.22 ± 2.68 vs 6.76 ± 3.25) (p<0.01%) and same was evident in vildagliptin-metformin (10.48 ±3.59 vs 7.74 ±3.92). There was no significant change in weight levels between the groups. ACER of vildagliptin-metformin therapy compared to glimepiride-metformin therapy was (₦175,357.66 vs ₦129,601.38). Vildagliptin-metformin having an ICER of (₦ 577,359.29). Conclusion: Combination therapy with glimepiride and metformin is a very cost-effective therapy for lowering fasting blood glucose (FBG). Vildagliptin, when used in conjunction with metformin, is more expensive but however more effective. Subsidies for the drug should be provided by the government and non-governmental organizations (NGOs).
Keywords: Pharmacoeconomics, Type 2 diabetes, Cost effectiveness, Incremental cost, Incremental effectiveness.
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