ArticleScientific reports2025
Cost effectiveness analysis of six non insulin agents for type 2 diabetes in Iran using a patient level simulation with UKPDS OM2.
Article in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Type 2 diabetes mellitus (T2DM) is a global healthcare challenge, requiring cost-effective treatments to improve patient outcomes and resource use. This study assesses the cost-effectiveness of six non-insulin agents (NIAs)-pioglitazone, metformin, dapagliflozin, sitagliptin, empagliflozin, and liraglutide for T2DM management in Iran. Using the UKPDS Outcomes Model 2 (UKPDS-OM2), a 40-year simulation from the healthcare system perspective analyzed data from 440 Iranian patients in the Diabetes Care (DiaCare) study, evaluating direct medical costs and quality-adjusted life years (QALYs). Costs were locally sourced, while treatment effects and complication disutility values came from international evidence. Incremental cost-effectiveness ratios (ICERs) were compared to a threshold of one-time GDP per capita, with uncertainty evaluated via 100 bootstrap iterations. Subgroup analyses were conducted based on sex, age (< 55 vs. ≥55 years), and diabetes duration (< 10 vs. ≥10 years), using the same simulation framework and assumptions. Pioglitazone proved least costly at $1,376.20 PPP with 8.47 QALYs, dominating sitagliptin and empagliflozin, and outperforming metformin, dapagliflozin, and liraglutide, which showed higher costs and limited QALY gains. Subgroup analyses showed that pioglitazone was cost-effective in men, younger patients, and those with longer diabetes duration, while metformin was preferred in women, older patients, and those with shorter disease duration. Bootstrap results showed pioglitazone cost-effective in 52% of iterations and metformin in 46%, with ICERs of $10,554.8-$56,857.13 PPP per QALY. Pioglitazone emerged as the cost-effective option, with metformin as a viable alternative in Iran's resource-constrained setting. Subgroup analyses highlighted the value of individualized treatment strategies, with pioglitazone and metformin demonstrating variable cost-effectiveness across sex, age, and diabetes duration groups.
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