Economic evaluation of pioglitazone hydrochloride in the management of type 2 diabetes mellitus in Canada

Introduction: Recently published clinical trial results have demonstrated that, in patients with type 2 diabetes mellitus, treatment with pioglitazone hydrochloride as a first-line therapy can lead to significant improvements in glycosylated haemoglobin, total cholesterol, high density lipoprotein cholesterol and triglycerides. Given the results of these trials, we assessed the cost effectiveness of the use of pioglitazone as a first-line therapy in Canada. Methods: A Markov model was used to determine the health outcomes and economic impact for patients with type 2 diabetes, from the perspective of a provincial ministry of health. The model incorporated six complications of diabetes: hypoglycaemia, acute myocardial infarction, stroke, lower extremity amputation, nephropathy, and retinopathy. Transition probabilities and costs were taken from published literature. Analysis compared treatment strategies with different first-line therapies: pioglitazone, glibenclamide (glyburide), metformin, and diet and exercise. Results: Compared with other strategies, a pioglitazone-based strategy was estimated to reduce the cumulative incidence of severe clinical events and long-term complications by between 23 and 36% and to increase discounted life expectancy by between 0.13 and 0.35 life-years. The discounted incremental cost per life-year gained of a first-line pioglitazone-based strategy was 54 000 Canadian dollars ($Can) compared with metformin, $Can42 000 compared with glibenclamide and $Can27 000 compared with diet and exercise. Conclusions: When compared with other currently funded chronic therapy, these results demonstrate that a treatment strategy employing pioglitazone as a first-line therapy may be cost effective for certain patient strata.