Cost-Consequences of Adding Gliclazide Modified Release to Metformin in Patients with Uncontrolled Type 2 Diabetes in the United Arab Emirates.

INTRODUCTION: Type 2 diabetes (T2D) is a chronic metabolic disease that is highly prevalent in the United Arab Emirates (UAE). This study aimed to assess the cost-consequences of adding gliclazide modified release (MR) to metformin in patients with inadequate glycaemic control on metformin alone and of switching patients currently receiving a combination of sitagliptin and metformin to a combination of gliclazide MR and metformin. METHODS: We developed a cost-consequences decision-tree model comparing gliclazide MR and sitagliptin as second-line add-ons to metformin. Based on 2014-2023 Dubai Real World Claims Database data, the model estimated health outcomes (number of patients reaching HbA1c targets of < 7% and ≤ 6.5% and cardiovascular [CV] events, i.e. myocardial infarction [MI] and hospitalisation for heart failure [HHF]), resource use (inpatient, emergency room, and outpatient visits, and hospital bed days), and costs (drug acquisition and medical costs) associated with the two therapies over a 1-year time horizon from the payer perspective. RESULTS: Adding gliclazide MR to metformin in a cohort of 126,074 patients with inadequate glycaemic control on metformin alone was estimated to result in 535 CV events and 35 deaths avoided per year at a cost of USD 12,250 per CV event avoided or USD 189,415 per death avoided. Switching patients currently treated with sitagliptin as an add-on to metformin to gliclazide MR was estimated to avert 26 cardiovascular events (5 MI and 21 HHF) and 2 deaths per year while providing annual savings of USD 5.11 million, including USD 4.77 million in drug acquisition costs and USD 330,837 in medical costs. CONCLUSION: Initiating gliclazide MR as an add-on treatment to metformin could help to reduce the clinical and economic burden of poorly controlled T2D among patients in the UAE. Switching patients from sitagliptin to gliclazide MR as a second-line treatment option could generate substantial cost savings.