Evaluation of Sitagliptin for the treatment of adult patients with type 2 diabetes mellitus: a systematic review of cost-effectiveness
DOI:
https://doi.org/10.29166/rfcmq.v45i2.2661Keywords:
sitagliptin, diabetes mellitus, cost-effectiveness, Diabetes Mellitus, Type 2, Economic EvaluationAbstract
Introduction: Type 2 diabetes mellitus is a global public health problem, being one of the main causes of mortality in Ecuador. Sitagliptin was the first locally marketed incretin-enhancing drug. Countries do not have unlimited resources to meet the health needs of their population, so they must adopt the most appropriate health interventions, considering the costs that a country can assume and sustain.
Objective: To synthesize the results of cost-effectiveness studies of sitagliptin for combined oral treatment of adult patients with type 2 diabetes, compared with sulfonylureas.
Methodology: This is a systematic review study without meta-analysis, conducted on PRISMA recommendations. The information search was structured under the PICO system. The searches were conducted in Pubmed, Tripdatabase and Pubmed Central; for articles on health technology evaluations, economic evaluations and clinical practice guides. For coverage policies, HTAiVortal and advanced Google were used.
Results: 3 clinical trials and 8 systematic reviews-meta-analysis, 2 cohort studies, 3 coverage policies and 1 cost-effectiveness study were selected. Three systematic reviews establish modest effects regarding the hypoglycemic effects of sitagliptin in adults and elderly, with a low risk of hypoglycemia. A meta-analysis of 25 clinical trials reported an increased cardiovascular risk in patients treated with sitagliptin. A systematic review with economic evaluation showed that sitagliptin with metformin was a cost-effective alternative, versus adding a sulfonylurea or roziglitazone.
Conclusions: Due to its cost-effectiveness profile, sitagliptin could be considered as a second drug for patients who do not achieve glycemic control with maximum doses of metformin, or where its association with a sulfonylurea is not feasible (due to risks of hypoglycemia or elderly).
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Copyright (c) 2020 Giovanni Rojas Velasco, Paola Solís, Richard Gaona, Altacílio Nunes
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