Costs and Consequences Associated With Newer Medications for Glycemic Control in Type 2 Diabetes

  1. Len Pogach, MD, MBA1,2
  1. 1Center for Healthcare Knowledge Management, Veterans Health Administration New Jersey, East Orange, New Jersey;
  2. 2Department of Preventive Medicine and Community Health, New Jersey Medical School–University of Medicine and Dentistry of New Jersey, Newark, New Jersey;
  3. 3RTI–UNC, Chapel Hill Center of Excellence in Health Promotion Economics, RTI International, Research Triangle Park, North Carolina.
  1. Corresponding author: Anushua Sinha, sinhaan1{at}


OBJECTIVE Newer medications offer more options for glycemic control in type 2 diabetes. However, they come at considerable costs. We undertook a health economic analysis to better understand the value of adding two newer medications (exenatide and sitagliptin) as second-line therapy to glycemic control strategies for patients with new-onset diabetes.

RESEARCH DESIGN AND METHODS We performed a cost-effectiveness analysis for the U.S. population aged 25–64. A lifetime analytic horizon and health care system perspective were used. Costs and quality-adjusted life years (QALYs) were discounted at 3% annually, and costs are presented in 2008 U.S. dollars. We compared three glycemic control strategies: 1) glyburide as a second-line agent, 2) exenatide as a second-line agent, and 3) sitagliptin as a second-line agent. Outcome measures included QALYs gained, incremental costs, and the incremental cost-effectiveness ratio associated with each strategy.

RESULTS Exenatide and sitagliptin conferred 0.09 and 0.12 additional QALYs, respectively, relative to glyburide as second-line therapy. In base case analysis, exenatide was dominated (cost more and provided fewer QALYs than the next most expensive option), and sitagliptin was associated with an incremental cost-effectiveness ratio of $169,572 per QALY saved. Results were sensitive to assumptions regarding medication costs, side effect duration, and side effect–associated disutilities.

CONCLUSIONS Exenatide and sitagliptin may confer substantial costs to health care systems. Demonstrated gains in quality and/or quantity of life are necessary for these agents to provide economic value to patients and health care systems.


  • The funding source had no role in the study's design, conduct, and reporting. The views expressed are solely those of the authors and do not necessarily represent the opinion of the Department of Veterans Affairs.

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received August 20, 2009.
    • Accepted December 21, 2009.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details.

| Table of Contents

This Article

  1. Diabetes Care vol. 33 no. 4 695-700
  1. Online-Only Appendix
  2. All Versions of this Article:
    1. dc09-1488v1
    2. 33/4/695 most recent