Clinical effectiveness and cost‐effectiveness of first‐line early combination of dipeptidyl peptidase 4 inhibitors and metformin in patients with type 2 diabetes in Taiwan: A modelling study

Abstract Aims Early dipeptidyl peptidase‐4 inhibitors and metformin (DPP4i‐Met) combination has been shown to extend the time to treatment failure and provide better glycaemic control for newly diagnosed type 2 diabetes (T2D) patients; however, the long‐term clinical and economic outcomes of early DPP4i‐Met combination remain unknown. We seek to assess the comparative long‐term clinical and cost‐effectiveness of DPP4i‐Met versus Met for treatment‐naïve T2D patients with inadequately controlled HbA1c (i.e., ≥8.5%). Methods The IQVIA CORE Diabetes Model was used to simulate the quality‐adjusted life years (QALYs) and healthcare costs over a lifetime from Taiwan's National Health Insurance Administration's perspective, with both QALYs and costs discounted at 3% annually. Model inputs were taken from the analyses of Taiwanese or Asian populations. Primary outcomes included the number needed to treat (NNT) to prevent one case of a clinical event and the incremental cost‐effectiveness ratios (ICERs). Costs are presented in 2023 US dollars. Results Over 40 years of projection, Met‐DPP4i‐treated patients had fewer complications than those using Met alone (e.g., lowering the incidence of stroke by 2.21% [2.68, 1.74]). The NNT using DPP4i‐Met versus Met alone to prevent one case of stroke, microalbuminuria, neuropathy and background retinopathy was 45, 135, 65 and 182, respectively. Such long‐term benefits in reducing costly complications offset the higher treatment cost of DDP4i‐Met versus Met ($5796 vs. $5484/person). As a result, using DPP4i‐Met versus Met yielded 0.086 QALYs gained and savings of $489 for overall treatment‐naïve T2D patients and 0.064 QALYs gained and savings of $714 for young‐onset T2D patients. Conclusions Early DPP4i‐Met provides long‐term clinical and economic benefits compared to Met alone for newly diagnosed T2D patients, including those with young‐onset T2D.