Cost-utility study of the combination of metformin with the different glucose-lowering medication classes in adults 80 aged and older

Introduction. - The elderly diabetes prevalence is greater than 20%. Drug hypoglycemia prevention is the key point in elderly diabetes therapeutic management. Today, there is no better drug to add to metformin in elderly uncontrolled diabetes. Materials and methods. - A literature review established the different hypoglycemic events and their occurrence probability. After determining the various procedures costs in the hypoglycemic events management and associated treatments costs, the cost of each type of hypoglycemic event (mild, moderate and severe) was calculated and the average cost of an hypoglycemic event (all intensities combined) was deduced. In order to determine the most appropriate drug association in the 80+ age group, a cost-utility study was conducted using the quality adjusted life years (QALY) determination of each strategy. Results. - The lower hypoglycemic strategies are metformine + DPP-4 inhibitor and metformin + GLP-1 analogs. Following the calculation of the different ICERs, the most economically and clinically advantageous drug combination is: metformin + DPP-4 inhibitor. Discussion conclusion. - Based on this study, the drug combination metformin + DPP-4 inhibitor would be the better therapy in elderly diabetic patient. However, this result needs to be adapted individually. (C) 2019 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.