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Comparison of lixisenatide in combination with basal insulin vs other insulin regimens for the treatment of patients with type 2 diabetes inadequately controlled by basal insulin: Systematic review, network meta‐analysis and cost‐effectiveness analysis
Author(s) -
Men Peng,
Qu Shuli,
Luo Wenting,
Li Chaoyun,
Zhai Suodi
Publication year - 2020
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13871
Subject(s) - lixisenatide , medicine , type 2 diabetes , randomized controlled trial , diabetes mellitus , insulin , basal (medicine) , meta analysis , endocrinology , basal insulin
Aims To evaluate the comparative efficacy and safety of lixisenatide combined with basal insulin (BI) vs intensive premix insulin (premix), BI plus prandial insulin with the main meal (basal‐plus) or progressively covering all meals (basal‐bolus) in patients with type 2 diabetes mellitus (T2DM) inadequately controlled by BI, and the long‐term cost‐effectiveness of lixisenatide from a Chinese healthcare system perspective. Materials and methods Randomized controlled trials (RCTs) published between 1998 and 2018 were systematically searched. The clinical efficacy and safety of each treatment were compared by network meta‐analysis (NMA). The IQVIA CORE Diabetes Model was used to estimate the lifetime quality‐adjusted life‐years (QALYs) and direct medical costs of patients treated with different strategies. Results Eight RCTs were finally included. Lixisenatide plus BI showed a similar reduction in HbA1c from baseline compared with premix, basal‐plus and basal‐bolus. There were significant differences in the change of body weight in favour of lixisenatide plus BI compared with the three insulin regimens. The risk of symptomatic hypoglycaemia of lixisenatide plus BI was significantly lower compared with premix and basal‐bolus. Lixisenatide plus BI was cost‐effective compared with premix, basal‐plus and basal‐bolus with incremental cost‐effectiveness ratios of Chinese yuan (CNY) 87 219, 48 173 and 48 670 per QALY gained, respectively, under the threshold of three times the gross domestic product (GDP) per capita in China. Conclusions Lixisenatide plus BI shows a similar HbA1c reduction compared with insulin regimens, accompanied by lower risk of hypoglycaemia and greater body weight reduction. It is a cost‐effective treatment alternative for patients with T2DM inadequately controlled by BI in China.