Imperial College London
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Dr M. Reza Skandari

Business School

Assistant Professor of Health Operations
 
 
 
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Contact

 

+44 (0)20 7594 8232r.skandari Website CV

 
 
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Location

 

380Business School BuildingSouth Kensington Campus

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Summary

 

Publications

Citation

BibTex format

@article{Choi:2022:10.7326/M21-2941,
author = {Choi, JG and Winn, AN and Skandari, MR and Franco, MI and Staab, EM and Alexander, J and Wan, W and Zhu, M and Huang, ES and Philipson, L and Laiteerapong, N},
doi = {10.7326/M21-2941},
journal = {Annals of Internal Medicine},
title = {First-line therapy for Type 2 Diabetes with sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists: a cost-effectiveness sStudy.},
url = {http://dx.doi.org/10.7326/M21-2941},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: Guidelines recommend sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP1) receptor agonists as second-line therapy for patients with type 2 diabetes. Expanding their use as first-line therapy has been proposed but the clinical benefits may not outweigh their costs. OBJECTIVE: To evaluate the lifetime cost-effectiveness of a strategy of first-line SGLT2 inhibitors or GLP1 receptor agonists. DESIGN: Individual-level Monte Carlo-based Markov model. DATA SOURCES: Randomized trials, Centers for Disease Control and Prevention databases, RED BOOK, and the National Health and Nutrition Examination Survey. TARGET POPULATION: Drug-naive U.S. patients with type 2 diabetes. TIME HORIZON: Lifetime. PERSPECTIVE: Health care sector. INTERVENTION: First-line SGLT2 inhibitors or GLP1 receptor agonists. OUTCOME MEASURES: Life expectancy, lifetime costs, incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS: First-line SGLT2 inhibitors and GLP1 receptor agonists had lower lifetime rates of congestive heart failure, ischemic heart disease, myocardial infarction, and stroke compared with metformin. First-line SGLT2 inhibitors cost $43 000 more and added 1.8 quality-adjusted months versus first-line metformin ($478 000 per quality-adjusted life-year [QALY]). First-line injectable GLP1 receptor agonists cost more and reduced QALYs compared with metformin. RESULTS OF SENSITIVITY ANALYSIS: By removing injection disutility, first-line GLP1 receptor agonists were no longer dominated (ICER, $327 000 per QALY). Oral GLP1 receptor agonists were not cost-effective (ICER, $823 000 per QALY). To be cost-effective at under $150 000 per QALY, costs for SGLT2 inhibitors would need to be under $5 per day and under $6 per day for oral GLP1 receptor agonists. LIMITATION: U.S. population and costs not generalizable internationally. CONCLUSION: As first-line agents, SGLT2 inhibitors and GLP1 receptor agonists would
AU  - Choi,JG
AU  - Winn,AN
AU  - Skandari,MR
AU  - Franco,MI
AU  - Staab,EM
AU  - Alexander,J
AU  - Wan,W
AU  - Zhu,M
AU  - Huang,ES
AU  - Philipson,L
AU  - Laiteerapong,N
DO  - 10.7326/M21-2941
PY  - 2022///
SN  - 0003-4819
TI  - First-line therapy for Type 2 Diabetes with sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists: a cost-effectiveness sStudy.
T2  - Annals of Internal Medicine
UR  - http://dx.doi.org/10.7326/M21-2941
UR  - https://www.ncbi.nlm.nih.gov/pubmed/36191315
UR  - https://www.acpjournals.org/doi/10.7326/M21-2941
ER  -
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