Applications of economic models in healthcare: the introduction of pioglitazone in Sweden.

Type 2 diabetes mellitus (T2DM) is a common disorder that is estimated to affect approximately 100 million people worldwide. Forecasts have suggested a substantial increase in incidence, mainly in Asia, Africa and North America. Thus, an increasing number of people with diabetes-related complications will have to be cared for in the future. This development will be a major health problem for the people affected, as well as a major health economic challenge for many countries. Thiazolidinediones represent a new class of drugs with a novel mechanism of action that addresses the root cause of T2DM. Their mode of action targets the core defect of T2DM, namely, insulin resistance. One of these drugs, pioglitazone, was recently approved by the Swedish authorities. To evaluate the cost effectiveness of this new drug, a published mathematical simulation model was used. This model was adapted to Swedish conditions, and local Swedish unit costs were put into the model. Modelling is necessary when performing economic evaluations in diabetes because of the complexity of the disease and its long time horizon. The cost-effectiveness analyses showed that the cost per life-year gained with pioglitazone combination therapy compared with current treatment ranged from 37,000 Swedish kronor (SEK) to SEK149,000. Although there is no threshold value for cost effectiveness in Sweden, the values presented would normally be regarded as cost effective in the Swedish healthcare system. Modelling studies are a good starting point, but long-term naturalistic studies are needed to establish the cost effectiveness of these new drugs.