Health and economic outcomes for exenatide once weekly, insulin, and pioglitazone therapies in the treatment of type 2 diabetes: a simulation analysis.

Vascular Health and Risk Management
Julia A GaeblerBarbara Peskin

Abstract

Patients with type 2 diabetes (T2DM) are at risk of long-term vascular complications. In trials, exenatide once weekly (ExQW), a GLP-1R agonist, improved glycemia, weight, blood pressure (BP), and lipids in patients with T2DM. We simulated potential effects of ExQW on vascular complications, survival, and medical costs over 20 years versus standard therapies. The Archimedes model was used to assess outcomes for ~25,000 virtual patients with T2DM (NHANES 1999-2006 [metformin ± sulfonylureas, age 57 years, body mass index 33 kg/m(2), weight 94 kg, duration T2DM 9 years, hemoglobin A1c [A1C] 8.1%]). The effects of three treatment strategies were modeled and compared to moderate-adherence insulin therapy: advancement to high-adherence insulin at A1C ≥ 8% (treat to target A1C < 7%) and addition of pioglitazone (PIO) or ExQW from simulation start. ExQW effects on A1C, weight, BP, and lipids were modeled from clinical trial data. Costs, inflated to represent 2010 $US, were derived from Medicare data, Drugstore.com, and publications. As ExQW was investigational, we omitted ExQW, PIO, and insulin pharmacy costs. By year 1, ExQW treatment decreased A1C (~1.5%), weight (~2 kg), and systolic BP (~5 mmHg). PIO and high-adherence insulin dec...Continue Reading

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Citations

Jan 24, 2013·Patient Preference and Adherence·Sheila A Doggrell
May 23, 2015·Expert Review of Cardiovascular Therapy·Marisa B SchauerhamerCarrie McAdam-Marx
Jan 7, 2016·Expert Review of Pharmacoeconomics & Outcomes Research·Tzahit Simon-TuvalDan Greenberg
Jun 15, 2016·CPT: Pharmacometrics & Systems Pharmacology·K GadkarS Ramanujan
Jun 27, 2013·Journal of Primary Care & Community Health·José A Pagán, Erin K Carlson
Apr 11, 2013·British Journal of Hospital Medicine·Patrick English
Jun 21, 2013·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Gina J RyanDawn D Smiley
May 1, 2013·Expert Review of Endocrinology & Metabolism·Courtney Aavang TibbleRobert R Henry

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Methods Mentioned

BETA
amputation

Clinical Trials Mentioned

NCT01144338

Software Mentioned

ExQW

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