Introduction
Drug prior authorization (PA) imposes a bureaucratic and economic burden on healthcare service providers and payers. A novel automated PA system may improve these drawbacks.
Methods
An ...historical cohort study from a large health maintenance organization in Israel, comparing manual versus automated PA mechanisms for diabetes mellitus (DM) drugs: sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 analogs (GLP1-A). We compared patients with DM, whose first drug applications were approved using the automated system, with similar patients whose first drug applications were approved by manual PA. The primary endpoint was the time elapsed from application approval to prescription filling (accessibility time). Secondary endpoints included the prescription filling rate at 7 and 30 days.
Results
In total, 1371 automated approved prescriptions and 1240 manually approved prescriptions were included in the analysis. Median accessibility time was one day (interquartile range (IQR) 0–5) with automated PA for both GLP1-A and SGLT2i, compared with four days (IQR 1–9) and three days (IQR 1–8), respectively, with the manual PA (p < 0.001). Eighty-four percent of GLP1-A automated PA approvals were filled within seven days compared with 70% with manual PA (p < 0.001). Similar results were seen with SGLT2i (80% vs. 72%, p < 0.008). No differences were observed at 30 days post-approval. Using logistic regression, odds for GLP1-A and SGLT2i prescription filling within seven days were 2.36 and 1.53 folds higher (respectively) with automated PA (p < 0.01).
Conclusions
Automated PA system improved access time to SGLT2i/GLP1-A seven days post-approval compared to manual PA.
Background: Dapagliflozin is a potential for combination therapy with metformin in T2DM. However, its cost-effectiveness relative to other alternatives in the Israeli healthcare setup remains ...unknown.
Objective: To evaluate the cost-effectiveness of dapagliflozin 10mg as add-on to metformin, compared to common alternatives (sitagliptin 100mg, glimepiride 2mg, liraglutide 1.2mg) based on Meuhedet health services database.
Methods: A cost-effectiveness evaluation was performed using the Cardiff diabetes model. A cohort of 1000 T2DM patients (ages 21 and older) who had received additional medication to metformin was randomly chosen from Meuhedet’s database. Baseline values for demographic and clinical variables prior to the add-on therapy, along with data from clinical trials served as inputs to the model. Simulation was performed for each drug, calculating its total costs and benefits (QALYs). The model’s time horizon was set to 40 years, annual discount rate for both costs and benefits was 3.5% and incremental cost effectiveness ratio (iCER) threshold was £20,000/QALY. Finally, single-variable and multivariable sensitivity analyses were performed.
Results: In the base-case scenario, dapagliflozin was found cost-effective compared to sitagliptin, liraglutide and glimepiride (iCER values of £1,232, £-16,517 and £13,476, respectively). For all comparisons, iCER was driven by differences in costs, while differences in QALYs were minimal. Dapagliflozin remained cost-effective even after performing sensitivity analyses. However, when performing the simulation under comparators’ generic competition scenario, dapagliflozin was no longer cost-effective compared to liraglutide (iCER =£24,900/QALY).
Conclusion: Dapagliflozin as add-on treatment to metformin was cost-effective compared to several alternatives in T2DM patients in Israel’s healthcare system. Additional research is needed in order to evaluate the effects of evolving new clinical data.
Disclosure
S. Moshel: Research Support; Self; AstraZeneca. M. Hirsch Vexberg: None. O. Shavit: None. Y. Toledano: None.
