Cost-effectiveness analysis of thiazolidinediones in uncontrolled type 2 diabetic patients receiving sulfonylureas and metformin in Thailand

Chirakup, Suphachai, Chaiyakunapruk, Nathorn, Chaikledkeaw, Usa, Pongcharoensuk, Petcharat, Ongphiphadhanakul, Boonsong, Roze, Stephane, Valentine, William J. and Palmer, Andrew J. (2008) Cost-effectiveness analysis of thiazolidinediones in uncontrolled type 2 diabetic patients receiving sulfonylureas and metformin in Thailand. Value in Health, 11 S1: S43-S51. doi:10.1111/j.1524-4733.2008.00366.x


Author Chirakup, Suphachai
Chaiyakunapruk, Nathorn
Chaikledkeaw, Usa
Pongcharoensuk, Petcharat
Ongphiphadhanakul, Boonsong
Roze, Stephane
Valentine, William J.
Palmer, Andrew J.
Title Cost-effectiveness analysis of thiazolidinediones in uncontrolled type 2 diabetic patients receiving sulfonylureas and metformin in Thailand
Journal name Value in Health   Check publisher's open access policy
ISSN 1098-3015
1524-4733
Publication date 2008-04-01
Year available 2008
Sub-type Article (original research)
DOI 10.1111/j.1524-4733.2008.00366.x
Open Access Status DOI
Volume 11
Issue S1
Start page S43
End page S51
Total pages 8
Editor J. Mauskopf
S. Priori
Place of publication Malden, MA, U.S.A.
Publisher Wiley-Blackwell Publishing Inc.
Language eng
Subject C1
920407 Health Protection and/or Disaster Response
920499 Public Health (excl. Specific Population Health) not elsewhere classified
111711 Health Information Systems (incl. Surveillance)
Formatted abstract
Objective:
The national essential drug committee in Thailand suggested that only one of thiazolidinediones be included in hospital formulary but little was know about their cost-effectiveness values. This study aims to determine an incremental cost-effectiveness ratio of pioglitazone 45 mg compared with rosiglitazone 8 mg in uncontrolled type 2 diabetic patients receiving sulfonylureas and metformin in Thailand.

Methods:

A Markov diabetes model (Center for Outcome Research model) was used in this study. Baseline characteristics of patients were based on Thai diabetes registry project. Costs of diabetes were calculated mainly from Buddhachinaraj hospital. Nonspecific mortality rate and transition probabilities of death from renal replacement therapy were obtained from Thai sources. Clinical effectiveness of thiazolidinediones was retrieved from a meta-analysis. All analyses were based on the government hospital policymaker perspective. Both cost and outcomes were discounted with the rate of 3%. Base-case analyses were analyzed as incremental cost per quality-adjusted life year (QALY) gained. A series of sensitive analyses were performed.

Results:

In base-case analysis, the pioglitazone group had a better clinical outcomes and higher lifetime costs. The incremental cost per QALY gained was 186,246 baht (US$ 5389). The acceptability curves showed that the probability of pioglitazone being cost-effective was 29% at the willingness to pay of one time of Thai gross domestic product per capita (GDP per capita). The effect of pioglitazone on %HbA1c decrease was the most sensitive to the final outcomes.

Conclusions:

Our findings showed that in type 2 diabetic patients who cannot control their blood glucose under the combination of sulfonylurea and metformin, the use of pioglitazone 45 mg fell in the cost-effective range recommended by World Health Organization (one to three times of GDP per capita) on average, compared to rosiglitazone 8 mg. Nevertheless, based on sensitivity analysis, its probability of being cost-effective was quite low. Hospital policymakers may consider our findings as part of information for the decision-making process.
Keyword Cost-effectiveness Analysis
pioglitazone
Rosiglitazone
Thiazolidinediones
Q-Index Code C1
Q-Index Status Confirmed Code
Additional Notes Special Issue: Pharmacoeconomics and Outcomes Research in Asia

 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 10 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 13 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Thu, 16 Apr 2009, 01:02:26 EST by Sarah Calderwood on behalf of School of Public Health