Skip to main content

Table 1 Model inputs: patient profiles, treatment effects, costs, and utility changes

From: Choice across 10 pharmacologic combination strategies for type 2 diabetes: a cost-effectiveness analysis

Patient profiles of the initial cohort

Value

Source

        

 Patient characteristics

Mean

SE

         

  Age, year

55.7

0.17

[21, 22]

        

  Female proportion, %

45.8

0.70

        

  Duration of diabetes, year

0.50

–

        

  Height, metera

1.65

0.02

        

  Smokers proportion, %

22

0.50

        

 Modifiable risk factors

Mean

SE

         

  HbA1c, %

8.40

0.03

[21, 22]

        

  TC, mg/dlb

193.05

0.66

        

  HDL-C, mg/dlb

46.33

0.20

        

  LDL-C, mg/dlb

111.97

0.51

        

  SBP, mmHg

129

0.18

        

  Weight, kgc

68.20

2.42

        

Treatment effects of first therapyd

Metformin

Source

        

Mean

SE

        

 HbA1c change, %

− 1.57

0.22

Meta-analysis and indirect treatment comparison

        

 TC change, mg/dlb

− 30.50

6.30

        

 HDL-C change, mg/dlb

10.04

2.36

        

 SBP change, mmHg

− 0.36

2.26

        

 Weight change, kge

− 7.51

1.09

        

 Symptomatic hypoglycemia, %f

1.81

1.04

        

 Severe hypoglycemia, %f

0.04

0.02

        

 Gastrointestinal reactions, %

2.15

1.06

        

Treatment effects of second therapyd

Metformin + sulfonylurea

Metformin + thiazolidinedione

Metformin + α-glucosidase inhibitor

Metformin + glinide

Metformin + DPP-4 inhibitor

Source

Mean

SE

Mean

SE

Mean

SE

Mean

SE

Mean

SE

 HbA1c change, %

− 2.61

0.18

− 2.40

0.22

− 2.41

0.28

− 2.64

0.25

− 2.52

0.22

Meta-analysis and indirect treatment comparison

 TC change, mg/dlb

− 6.56

2.36

− 8.88

4.81

− 31.66

12.06

− 2.70

5.10

− 24.32

5.46

 HDL-C change, mg/dlb

− 1.16

3.25

5.41

5.73

11.58

5.52

− 4.63

6.50

2.70

4.24

 SBP change, mmHg

− 3.80

1.17

− 4.64

3.06

− 3.68

3.02

–

–

− 6.22

2.52

 Weight change, kge

− 0.95

1.21

− 1.42

1.69

− 2.70

1.60

− 8.06

1.43

− 4.14

1.36

 Symptomatic hypoglycemia, %f

4.46

0.57

1.52

0.98

0

1.37

0

1.19

0.54

1.06

 Severe hypoglycemia, %f

0.09

0.01

0.03

0.02

0

0.03

0

0.02

0.01

0.02

 Gastrointestinal reactions, %

4.62

0.59

7.62

1.41

9.62

1.55

7.62

1.74

6.62

1.27

Treatment effects of third therapyd

Metformin + insulin

Metformin + GLP-1 receptor agonist

Source

      

Mean

SE

Mean

SE

      

 HbA1c change, %

− 2.51

0.29

− 2.89

0.20

Meta-analysis and indirect treatment comparison

      

 TC change, mg/dlb

− 69.50

12.15

− 55.60

7.88

      

 HDL-C change, mg/dlb

–

–

0

5.71

      

 SBP change, mmHg

–

–

− 7.38

1.62

      

 Weight change, kge

− 4.22

2.69

− 7.54

0.92

      

 Symptomatic hypoglycemia, %f

3.47

0.58

3.47

0.58

      

 Severe hypoglycemia, %f

0.07

0.01

0.07

0.01

      

 Gastrointestinal reactions, %

11.78

2.22

6.78

0.98

      

Costs of glucose-lowering treatments

Cost, ¥ ($)g,i

Individual drug

Cost, ¥ ($)g,h

Source

 

 Metformin

679.05 (98.30)

Metformin

679.05 (98.30)

[23]

 

 Sulfonylurea

632.74 (91.60)

Glyburide

2.70 (0.39)

Glimepiride

1210.95 (175.30)

Gliclazide

414.59 (60.02)

Glipizide

902.72 (130.68)

 Thiazolidinedione

1148.06 (166.19)

Rosiglitazone

938.83 (135.90)

Pioglitazone

1357.28 (196.48)

 α-Glucosidase inhibitor

1815.60 (262.83)

Acarbose

1830.98 (265.05)

Voglibose

1356.07 (196.30)

Miglitol

2259.77 (327.12)

 Glinide

1124.13 (162.73)

Repaglinide

1259.80 (182.37)

Nateglinide

988.46 (143.09)

 DPP-4 inhibitor

3069.95 (444.41)

Sitagliptin

2814.34 (407.40)

Saxagliptin

3017.02 (436.74)

Vildagliptin

3192.47 (462.14)

Linagliptin

3137.21 (454.14)

Alogliptin

3188.72 (461.60)

 GLP-1 receptor agonist

14,578.94 (2110.44)

Exenatide

18,990.33 (2749.03)

Liraglutide

10,167.55 (1471.85)

 Insulin cost per kg weight per day

0.137 (0.020)

–

–

  

Costs and utility changes associated with diabetes-related events

Fatal costs, ¥ ($)g

Non-fatal costs, ¥ ($)g

Maintenance costs, ¥ ($)g

Source

Utility change

Source

Mean

SE

Mean

SE

Mean

SE

Mean

SE

 Ischemic heart disease

21,574.18 (3123.07)

6359.88 (920.65)

23,860.32 (3454.01)

1576.61 (228.23)

3293.02 (476.70)

435.07 (62.98)

Claims data

− 0.028

0.005

[24]

 Myocardial infarction

39,463.58 (5712.74)

8360.32 (1210.24)

53,131.50 (7691.30)

3774.74 (546.43)

6543.01 (947.16)

–

− 0.028

0.005

 Congestive heart failure

35,521.34 (5142.06)

13,196.13 (1910.27)

32,469.77 (4700.31)

6315.33 (914.21)

3113.24 (450.67)

1797.6 (260.22)

− 0.028

0.005

 Stroke

69,427.06 (10,050.24)

18,792.10 (2720.34)

25,465.96 (3686.44)

2418.01 (350.03)

4274.23 (618.74)

735.06 (106.41)

− 0.101

0.006

 Amputation

–

–

22,281.86 (3225.52)

–

3542.36 (512.79)

–

− 0.118

0.009

 Blindness

–

–

15,846.21 (2293.89)

617.89 (89.45)

5227.01 (756.66)

484.87 (70.19)

− 0.022

0.005

 End-stage renal disease

15,531.40 (2248.32)

3715.52 (537.86)

16,002.73 (2316.55)

554.07 (80.21)

5595.21 (809.96)

543.32 (78.65)

− 0.058

0.006

 Symptomatic hypoglycemia

–

 

0

 

–

 

Assumed

− 0.007

0.002

 Severe hypoglycemia

–

 

4116.10 (595.85)

 

–

 

[25]

− 0.008

0.004

 Gastrointestinal reactions

–

 

0

 

–

 

Assumed

− 0.034

0

[26]

 BMI per unit increase

–

 

–

 

–

  

− 0.0061

0.001

[27]

 BMI per unit decrease

–

 

–

 

–

  

+ 0.0061

0.001

BMI-related costs

Costs, ¥ ($)g

BMI

Costs, ¥ ($)g

BMI

Costs, ¥ ($)g

Source

 

 ≤ 23

0

29

14,230.2 (2059.96)

35

29,252.9 (4234.64)

[28]

 

 24

1711.3 (247.73)

30

16,734.0 (2422.41)

36

31,756.7 (4597.09)

 

 25

4215.1 (610.18)

31

19,237.8 (2784.86)

37

34,260.5 (4959.54)

 

 26

6718.9 (972.63)

32

21,741.6 (3147.31)

38

36,764.3 (5321.99)

 

 27

9222.7 (1335.08)

33

24,245.4 (3509.76)

39

39,268.0 (5684.42)

 

 28

11,726.4 (1697.51)

34

26,749.1 (3872.19)

≥ 40

41,771.8 (6046.87)

 
  1. Sulfonylurea includes glyburide, glimepiride, gliclazide, and glipizide. Thiazolidinedione includes rosiglitazone and pioglitazone. α-Glucosidase inhibitor includes acarbose, voglibose, and miglitol. Glinide includes repaglinide and nateglinide. DPP-4 inhibitor includes sitagliptin, saxagliptin, vildagliptin, linagliptin, and alogliptin. Insulin includes various kinds of insulin and insulin analogs. GLP-1 receptor agonist includes exenatide and liraglutide
  2. BMI body mass index, DPP-4 dipeptidyl peptidase 4, GLP-1 glucagon-like peptide 1, HbA1c glycosylated hemoglobin Alc, HDL-C high-density lipoprotein-cholesterol, LDL-C low-density lipoprotein-cholesterol, RCT randomized controlled trial, SBP systolic blood pressure, SE standard error, TC total cholesterol
  3. aAs only BMI and weight of the patients were reported, height was calculated by: sqrt (weight/BMI)
  4. bThe unit of cholesterol in the included 324 RCTs was mmol/l, while the Cardiff model requires mg/dl, which was converted by: 1 mg/dl = 0.0259 mmol/l [29]
  5. cThe “criteria of weight for adults” published by the National Health Commission of China defines weight categories as underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24 kg/m2), overweight (24 ≤ BMI < 28 kg/m2), and obese (BMI ≥ 28 kg/m2) [30]. As the BMI of patients in our initial cohort was 25 kg/m2, they were overweight
  6. dThe treatment effect of each glucose-lowering treatment was with or without a background of lifestyle interventions
  7. eOnly BMI change was reported in the 324 RCTs, while the Cardiff model requires weight change; thus, it was calculated by: weight = BMI × height2
  8. fHypoglycemia is differentiated as symptomatic and severe ones in the Cardiff model, but most of the 324 RCTs did not clearly differentiate between symptomatic and severe episodes; thus, we estimated that a rate of 2% represented the proportion of severe cases out of all hypoglycemia events [25]
  9. gFor the costs, data are 2019 Chinese yuan, ¥ (2019 US dollar, $). One US dollar was equal to ¥6.908 in 2019 [31]
  10. hAnnual pharmacy cost of a drug was calculated as its retail price times its annual dose. The retail price was sourced from government medicine purchase platform, and the drug dose was obtained from the 324 RCTs. One year was counted as 365 days. For individual drugs, only the drugs reported in the 324 RCTs were included
  11. iAnnual pharmacy costs of each drug class were calculated based on a simple arithmetic average of the costs of individual drugs
Back to article page

BMC Medicine

ISSN: 1741-7015

Contact us