Evidence map›Paper›PMID 21969406›Full record

SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2011

Cost-effectiveness of second-line antihyperglycemic therapy in patients with type 2 diabetes mellitus inadequately controlled on metformin.

Scott Klarenbach, Chris Cameron, Sumeet Singh, Ehud Ur

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 6 pooled it
3.3field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 6 syntheses or guidelines pooled it, 58 citations in OpenAlex.

  1. Pooled it
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  5. Pooled it
  6. Pooled it
  7. Severe hypoglycemia in the Look AHEAD Trial.Journal of diabetes and its complications · 2016
    Trial
  8. Article
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  13. Review
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  15. Review
  16. The Standard of Care in Type 2 Diabetes: Re-evaluating the Treatment Paradigm.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2019
    Review
  17. Article
  18. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 1 country.

Scott KlarenbachDepartment of Medicine, University of Alberta, Edmonton, Alta.
Chris Cameron
Sumeet Singh
Ehud Ur
GlaxoSmithKline (Canada) · CANordion (Canada) · CAUniversity of Alberta · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMetformin is widely accepted as first-line pharmacotherapy for patients with type 2 diabetes mellitus when glycemic control cannot be achieved by lifestyle interventions alone. However, uncertainty exists regarding the optimal second-line therapy for patients whose diabetes is inadequately controlled by metformin monotherapy. Increased use of newer, more costly agents, along with the rising incidence of type 2 diabetes, carries significant budgetary implications for health care systems. We conducted this analysis to determine the relative costs, benefits and cost-effectiveness of options for second-line treatment of type 2 diabetes.

methodsWe used the United Kingdom Prospective Diabetes Study Outcomes Model to forecast diabetes-related complications, quality-adjusted life-years and costs of alternative second-line therapies available in Canada for adults with type 2 diabetes inadequately controlled by metformin. We obtained clinical data from a systematic review and mixed treatment comparison meta-analysis, and we obtained information on costs and utilities from published sources. We performed extensive sensitivity analyses to test the robustness of results to variation in inputs and assumptions.

resultsSulphonylureas, when added to metformin, were associated with the most favourable cost-effectiveness estimate, with an incremental cost of $12 757 per quality-adjusted life-year gained, relative to continued metformin monotherapy. Treatment with other agents, including thiazolidinediones and dipeptidyl peptidase-4 inhibitors, had unfavourable cost-effectiveness estimates compared with sulphonylureas. These results were robust to extensive sensitivity analyses.

interpretationFor most patients with type 2 diabetes that is inadequately controlled with metformin monotherapy, the addition of a sulphonylurea represents the most cost-effective second-line therapy.

Indexed as

Computer SimulationCost-Benefit AnalysisDiabetes Mellitus, Type 2Dipeptidyl-Peptidase IV InhibitorsDrug Therapy, CombinationGlycated HemoglobinHumansHypoglycemic AgentsMetforminModels, BiologicalQuality-Adjusted Life YearsSulfonylurea CompoundsThiazolidinedionesDipeptidyl-Peptidase IV InhibitorsGlycated HemoglobinHypoglycemic AgentsMetforminSulfonylurea CompoundsThiazolidinediones

Identifiers

PMID21969406
PMCPMC3216433
OpenAlexW2137746085

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.