Clinical and economic evaluation of exenatide for formulary decisions

Summary

This study was designed to provide an assessment for healthcare organisations to make formulary decisions on Byetta®* (exenatide).

The drug was shown to be efficacious in treating type 2 diabetes mellitus when used as adjunctive therapy with other oral antidiabetic drugs. The Centre for Outcomes Research Diabetes Model analyses suggested that the drug treatment fails to achieve a threshold level of the incremental cost-effectiveness ratio until 50 years have passed. Sensitivity analyses suggested that maintaining an appropriate haemoglobin A_1c level is essential for the treatment to be cost effective. A budget impact analysis with a hypothetical plan produced a 2.1 cent base case compliance-adjusted, per member per month cost in Year 1. One-way sensitivity analyses indicated that the two major determinants are compliance and the percentage of individuals expected to be on exenatide.

The author's conclude that further research is needed to include exenatide for the formulary decision.     

A new angle for glp-1 receptor agonist: the medical economics argument

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are relatively new medications for diabetes that offer a weight-loss profile that can be considered desirable for patients with both type 2 diabetes (T2D) and obesity. GLP-1 RA are effective in combination with insulin, and even slightly superior or at least equal to short-acting insulin in T2D; however, since they work in the incretin system, they may not be effective in long-standing disease. Additionally, only recently have publications reported their cardiovascular safety, and there is limited evidence for long-term effectiveness. The work presented by Huetson et al. offers a much needed perspective through a medical economic model for the long term cost-effectiveness of GLP-1 RA. The authors found benefits in quality-adjusted life years and reduced lifetime healthcare costs. While there are a few limitations, this study contributes to the understanding of these agents and their impact on the epidemics of obesity in T2D, where weight management is no longer an option, but an essential component of the diabetes plan of care.     

Testing a Structural Model of Psychological Well-Being and Constraints Negotiation in Recreational Sports Participation in Individuals with Type 2 Diabetes

The relationships among psychological well-being, constraints, negotiation, and participation were examined using structural equation modeling in patients with type 2 diabetes using a cross-sectional survey approach (N = 283). Despite a direct negative effect of constraints and a positive effect of negotiation on participation in recreational sports, we found no significant effect of constraints on the negotiation efforts of respondents. Instead, psychological well-being played an important role in the process. A higher level of psychological well-being not only directly decreases participation, but also indirectly increases participation by reducing constraints and promoting negotiation efforts. In particular, environmental mastery and personal growth indirectly increase participation by mitigating constraints; personal growth and positive relationships stimulate participation by boosting negotiation efforts and diminishing the discouraging impact of constraints on negotiation. However, a stronger purpose in life decreases both negotiation and participation.     

Empowering health care consumers in the era of Internet of Things

The Internet of Things (IoT) is emerging as a significant development in information technology that aims to link the digital world with the real world to improve human life. IoT refers to digital tools collecting data and providing hyper-personalized information to its users. With the rapid integration of the IoT in the healthcare sector (HIoT), it has been presumed that HIoT devices have an empowering effect on patients; however, this has yet to be investigated. Furthermore, the literature reveals a lack of consistency regarding the definition of patient empowerment. This study aims to fill these gaps and investigates whether HIoT systems increase user empowerment for individuals suffering from chronic illnesses. It also examines how empowerment is defined for HIoT users. To answer these two research questions, we conducted a qualitative research study consisting of 20 semi-structured, in-depth interviews carried out with individuals suffering from Type 1 diabetes (T1D). The interviews were transcribed and content analysis was conducted on the data. The study enabled us to examine whether and how the HIoT triggered empowerment for patients suffering from T1D. Findings reveal four main dimensions of empowerment for HIoT users: (1) self-efficacy, (2) patient control, (3) knowledge development and (4) participation in the decision-making process along with the doctor. Results also highlight that participants feel empowered by personal acceptance of living with their health condition and social support. In addition, the analysis led to the identification of the barriers which need to be overcome to ensure that HloT systems improve patient empowerment.     

基于灰色系统的治未病策略

治未病的主要中医理念之一为未病先防。以糖尿病为例,从患者的各生活习性着手,构建灰色关联模型,求得各生活习性对该糖尿病的影响权重与关联度矩阵,进而给出治未病方案。     

Effects of Incumbency and R&D Affiliation on the Legitimation of Electric Vehicle Technologies

Non-economic forces distort “rational” competitions among emerging technologies and associated trajectories. For example, incumbent and credibly affiliated firms use their legitimacy to promote their technological preferences and denigrate the efforts of less legitimate firms. This article reports results of a study which examined these dynamics in the competition among emerging electrochemical innovations aimed at the electric vehicle industry. It also presents the first-known use of the technology forecasting technique called morphological analysis in business academia. Similarities and differences between media representations of innovation activities, versus actual industry-wide developments, were found to have theoretical and practitioner implications. It was found that (1) incumbent firms were not participating meaningfully, rendering that variable largely moot; (2) effects of R&D affiliation were marginally significant; that while (3) performance advantages and disadvantages were reported in the media much more frequently than respective cost-price advantages and disadvantages, that (4) the relative performance advantages and disadvantages of competing innovations were reported in a balanced way, but that (5) the pattern of reports concerning cost-price was unbalanced in a way that favored the dominant design plus relatively modest departures from it. The overall interpretation indicated that relatively modest types of innovations were “winning” the early battle in a subtle but important way, despite representing a trajectory that was not certain to be the most rational, from a performance and/or cost-price focus.     

2型糖尿病社区管理的效果分析

为探究2型糖尿病患者社区管理的效果,随机选取2个社区卫生服务站2型糖尿病患者91例为社区管理组,同时随机选取黄石理工学院附属医院专科门诊2型糖尿病患者86例为医院对照组。2年后比较分析2组患者的体重指数（BMI）、空腹血糖（FPG）、餐后2h血糖（2hPG）及糖化血红蛋白（HbAlC）等指标。结果为：社区管理组患者的各项指标明显优于医院对照组,且2组指标存在显著性差异（P〈0．01）。规范的社区管理可提高2型糖尿病的治疗效果。     

Do menu-labelling laws translate into results? The disparate impacts on population obesity and diabetes

ABSTRACT

Despite their joint importance to health care costs, the nature of the relationship between obesity and diabetes is contested within the medical literature. We leverage California’s 2008 law mandating menu-labelling at restaurants to confirm that the law reduced obesity compared to the experience of counties not subject to such regulation. Despite this reduction in obesity, we find no California-specific reduction in the prevalence of diabetes and we find a significantly positive impact on the likelihood of new diabetes diagnoses. We evaluate a range of potential hypotheses that rationalize the divergent findings on obesity and diabetes.     

Cost-effectiveness analysis of dapagliflozin treatment versus metformin treatment in Chinese population with type 2 diabetes

Background and objective: Dapagliflozin is the first SGLT2 inhibitor available in China, where the disease burden of diabetes and its complications is very heavy. Because a new diabetes treatment strategy for diabetes should consider its cost-effectiveness, compared with an existing treatment, this study aimed to examine the cost-effectiveness between dapagliflozin and metformin treatment in China.

Methods: The Cardiff Diabetes Model (CDM) was used to estimate cost effectiveness and macro- and micro-vascular outcomes of dapagliflozin vs metformin. The CDM effectiveness inputs were derived from indirect comparative efficacy data from meta-analysis of 71 studies comparing monotherapy and add-on therapy of dapagliflozin vs metformin: dapagliflozin or metformin monotherapy, add-on therapy with other oral hypoglycemic agents, and add-on therapy with insulin. Direct medication costs and medical costs on treating diabetes were calculated based on published and local sources. A discount rate of 3% was applied to both costs and health effects. Univariate and probabilistic sensitivity analyses (PSA) were performed to assess uncertainties.

Results: The total healthcare costs accumulated over the lifetime on dapagliflozin treatment arm was 8,626 Chinese yuan higher than the metformin treatment arm for an individual patient, and the quality adjusted life years (QALYs) gained with dapagliflozin treatment was 0.8 more than metformin treatment. Therefore, an incremental cost-effectiveness ratio was 10,729 yuan per QALY gained for dapagliflozin treatment arm vs metformin treatment arm. The cost-effectiveness results were robust to various sensitivity analyses.

Conclusion: Dapagliflozin treatment was more cost-effective compared with metformin treatment for Chinese type 2 diabetes patients. However, the findings of favorable cost-effectiveness results for dapagliflozin are largely driven by the effects of favorable weight profile on clinical, utility, and costs in the Cardiff model.