INTRODUCTION: The aim of this study was to evaluate the cost-effectiveness of glyburide compared with metformin in the treatment of gestational diabetes based on the results of randomized clinical trials.
METHODS: Baseline model parameters were sourced from three randomized clinical trials. Data were extracted for costs and outcomes of treatment. Costs were discounted annually at 3%. Patients' outcomes were modeled and incremental cost-effectiveness ratios were calculated from a societal perspective. The robustness of the results was performed by univariate and probabilistic sensitivity analyses by examining scatterplots of incremental costs and effectiveness. TreeAge Pro 2013 was used for data analysis.
RESULTS: In the base case, compared with metformin, treatment with glyburide resulted in lower incidence of both symptomatic and severe hypoglycemic events, resulting in an incremental benefit of 1.90 quality-adjusted life-years (QALYs) and an incremental cost-effectiveness ratio of 4,736 per QALY gained. Univariate sensitivity analysis showed findings to be robust under almost all scenarios. Probabilistic sensitivity analysis showed that there is a 62.7% probability that treatment with glyburide was associated with a cost per QALY of less than $10,000. In 76% of simulations, glyburide was cost-saving in comparison with metformin.
CONCLUSION: This decision analysis demonstrates that glyburide is a more cost-effective strategy in treating gestational diabetes mellitus compared with metformin. The findings of the sensitivity analysis suggest that the results are robust to input variables and modeling assumptions.
(C) 2014 by The American College of Obstetricians and Gynecologists.