Online ISSN 2313-1519
Print    ISSN 1812-2892
Abstract - Systematic review of clinical and economic effectiveness of vildagliptin in type 2 diabetic patients with poor glycemic control on monotherapy with metformin
[PDF]            [Full text/HTML]           
Alima Almadiyeva, Zhanay Akanov, Venera Almatova, Karlygash Absattarova

ABSTRACT

Aim: A study was conducted to assess the clinical and economic effectiveness of vildagliptin in adults with type 2 diabetes mellitus (T2DM) with poor glycemic control against the metformin monotherapy.

Materials and methods: 280 sources were identified in accordance with the search strategy; 40 sources were subjected to critical analysis, of which 22 full-text publications were included in the present study.

Results and discussion: Significant advantages of the use of vildagliptin in combination with metformin in improving glycemic control, regardless of the initial level of glycosylated hemoglobin (HbA1c), age or body mass index (BMI) compared with other dipeptidyl peptidase-4 inhibitors, were found; Combination therapy using 50 mg of vildagliptin and metformin twice daily significantly reduced the mean baseline HbA1c (-0.7 to -0.9%) and fasting blood glucose levels (-1.4 to 0.1 mmol/l) compared with placebo, as well as with other dipeptidyl peptidase-4 inhibitors; this combination also led to the greatest increase in QALYs (0.18 over the life span) among dipeptidyl peptidase-4 inhibitors compared to treatment with a combination of metformin and glimepiride. Thus, the combination of metformin and vildagliptin gives advantages in efficiency and additional mechanisms of action, since it does not increase the risk of hypoglycemia and does not contribute to weight gain. 

Conclusion: Combination therapy using metmorfin and vildagliptin is more cost-effective, since it does not increase the risk of hypoglycemia and does not lead to increasing weight.

Keywords: type 2 diabetes mellitus (T2DM), dipeptidyl peptidase-4 inhibitors, efficacy, safety

Corresponding Author: Karlygash Absattarova, Kazakh Agency for Health Technology Assessment, Astana, Republic of Kazakhstan. E-mail: karlygash_absatt@mail.ru

 

REFERENCES

1. World Health Organization. Media Centre. Diabetes (Fact sheet no. 312. [Cited on: 31 January 2018] Available at: http://www.who.int/mediacentre/factsheets/ fs312/en/

2. Ogurtsova K., da Rocha Fernandes J. D., Huang Y., et al. Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Research and Clinical Practice. 2017; 128:40–50. https://doi.org/10.1016/j.diabres.2017.03.024

3. Online version of IDF Diabetes Atlas. International Diabetes Federation 2013.www.idf.org/ diabetes atlas. Last Accessed July 2014., доступно на сайтеhttps://www.diapedia.org/

4. World Health Organization. Global report on diabetes. Geneva: 2016.- 88 p

5. Dall T.M. et al. The economic burden of elevated blood glucose levels in 2012: diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes. Diabetes Care. 2014; 37(12):3172-3179. https://doi.org/10.2337/dc14-1036

6. UK Prospective Diabetes Study (UKPDS) Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type2 diabetes (UKPDS 33). Lancet. 1998; 352(9131):837–853. https://doi.org/10.1016/S0140-6736(98)07019-6

7. Ashcroft FM, Rorsman P. Diabetes mellitus and the beta cell: the last ten years. Cell. 2012; 148(6):1160–1171. https://doi.org/10.1016/j.cell.2012.02.010

8. Bhutani J, Bhutani S. Worldwide burden of diabetes. Indian Journal of Endocrinology and Metabolism. 2014; 18(6):868-870. https://doi.org/10.4103/2230-8210.141388

9. UK Prospective Diabetes Study (UKPDS) Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type2 diabetes (UKPDS 33). Lancet. 1998; 352(9131):837–853. https://doi.org/10.1016/S0140-6736(98)07019-6

10. Prikaz Ministra zdravookhraneniya i sotsial'nogo razvitiya Respubliki Kazakhstan ot 16 sentyabrya 2015 goda № 725 «Ob utverzhdenii tarifov na meditsinskiye uslugi v ramkakh garantirovannogo ob"yema besplatnoy meditsinskoy pomoshchi» (s izmeneniyami i dopolneniyami po sostoyaniyu na 15.08.2017 g.) i klinicheskikh protokolov diagnostiki i lecheniya (odobrennykh protokol'nym resheniyem Ob"yedinennoy komissii po kachestvu meditsinskikh uslug Ministerstva zdravookhraneniya Respubliki Kazakhstan ot «10» noyabrya 2017 goda №32) 

11. Tarify na meditsinskiye uslugi v ramkakh garantirovannogo ob"yema besplatnoy meditsinskoy pomoshchi utverzhdennyye Prikazom Ministra zdravookhraneniya i sotsial'nogo razvitiya Respubliki Kazakhstan ot 16 sentyabrya 2015 goda № 725 (s izmeneniyami i dopolneniyami po sostoyaniyu na 15.08.2017 g.)

12. Ministerstvo natsional'noy ekonomiki Respubliki Kazakhstan. Komitet po statistike. Dinamika osnovnykh sotsial'no-ekonomicheskikh pokazateley. Available at: www.stat.gov.kz

13. Clarke P., Gray A., Holman R. Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Med. Decis. Making. 2002; 22(4):340-349. https://doi.org/10.1177/027298902400448902

14. Manns B, Meltzer D, Taub K, et al. Illustrating the impact of including future costs in economic evaluations: an application to end-stage renal disease care. Health Econ. 2003; 12:949-58. https://doi.org/10.1002/hec.790

15. Currie CJ, Morgan CL, Poole CD, et al. Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes. Curr Med ResOpin. 2006; 22:1523-34. https://doi.org/10.1185/030079906X115757

16. Erhardt W, Bergenheim K, Duprat-Lomon I, et al. Cost effectiveness of saxagliptin and metformin versus sulfonylurea and metformin in the treatment of type 2 diabetes mellitus in Germany: a Cardiff diabetes model analysis. Clin Drug Investig. 2012; 32:189-202. https://doi.org/10.2165/11597060-000000000-00000

17. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press. 2015; (4)455.

Volume 4, Number 50 (2018)