Back to Browse Journals » Vascular Health and Risk Management » Volume 8

Health and economic outcomes for exenatide once weekly, insulin, and pioglitazone therapies in the treatment of type 2 diabetes: a simulation analysis

Authors Gaebler JA, Soto-Campos G, Alperin P, Cohen M, Blickensderfer A, Wintle M, Maggs D, Hoogwerf B, Han J, Pencek R, Peskin B

Published Date April 2012 Volume 2012:8 Pages 255—264


Received 1 December 2011, Accepted 17 February 2012, Published 23 April 2012

Julia A Gaebler1, Gerardo Soto-Campos2, Peter Alperin2, Marc Cohen2, Amy Blickensderfer1, Matthew Wintle1, David Maggs1, Byron Hoogwerf3, Jenny Han1, Richard Pencek1, Barbara Peskin2
1Amylin Pharmaceuticals, Inc, San Diego CA, 2Archimedes Inc, San Francisco CA, 3Eli Lilly and Company, Indianapolis, IN, USA

Background: Patients with type 2 diabetes (T2DM) are at risk of long-term vascular complications. In trials, exenatide once weekly (ExQW), a GLP-1R agonist, improved glycemia, weight, blood pressure (BP), and lipids in patients with T2DM. We simulated potential effects of ExQW on vascular complications, survival, and medical costs over 20 years versus standard therapies.
Patients and methods: The Archimedes model was used to assess outcomes for ~25,000 virtual patients with T2DM (NHANES 1999–2006 [metformin ± sulfonylureas, age 57 years, body mass index 33 kg/m2, weight 94 kg, duration T2DM 9 years, hemoglobin A1c [A1C] 8.1%]). The effects of three treatment strategies were modeled and compared to moderate-adherence insulin therapy: advancement to high-adherence insulin at A1C ≥ 8% (treat to target A1C < 7%) and addition of pioglitazone (PIO) or ExQW from simulation start. ExQW effects on A1C, weight, BP, and lipids were modeled from clinical trial data. Costs, inflated to represent 2010 $US, were derived from Medicare data,, and publications. As ExQW was investigational, we omitted ExQW, PIO, and insulin pharmacy costs.
Results: By year 1, ExQW treatment decreased A1C (~1.5%), weight (~2 kg), and systolic BP (~5 mmHg). PIO and high-adherence insulin decreased A1C by ~1%, increased weight, and did not affect systolic BP. After 20 years, A1C was ~7% with all strategies. ExQW decreased rates of cardiovascular and microvascular complications more than PIO or high-adherence insulin versus moderate-adherence insulin. Over 20 years, ExQW treatment resulted in increased quality-adjusted life-years (QALYs) of ~0.3 years/person and cost savings of $469/life-year versus moderate adherence insulin. For PIO or high-adherence insulin, QALYs were virtually unchanged, and costs/life-year versus moderate-adherence insulin increased by $69 and $87, respectively.
Conclusions: This long-term simulation demonstrated that ExQW treatment may decrease rates of cardiovascular and some microvascular complications of T2DM. Increased QALYs, and decreased costs were also projected.

Keywords: diabetes, modeling, exenatide, pioglitazone, insulin, cardiovascular risk

Download Article [PDF] View Full Text [HTML] 

Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at:

Readers of this article also read:

Opioid rotation in patients initiated on oxycodone or morphine: a register study

Ericson L, Ambring A, Björholt I, Dahm P

Journal of Pain Research 2013, 6:379-386

Published Date: 20 May 2013

Treatment with exenatide once weekly or twice daily for 30 weeks is associated with changes in several cardiovascular risk markers

Chiquette E, Toth PP, Ramirez G, Cobble M, Chilton R

Vascular Health and Risk Management 2012, 8:621-629

Published Date: 12 November 2012

The impact of initial statin treatment decisions on cardiovascular outcomes in clinical care settings: estimates using the Archimedes Model

van Herick A, Schuetz CA, Alperin P, Bullano MF, Balu S, Gandhi S

ClinicoEconomics and Outcomes Research 2012, 4:337-347

Published Date: 9 November 2012

Understanding and meeting injection device needs in multiple sclerosis: a survey of patient attitudes and practices

Verdun di Cantogno E, Russell S, Snow T

Patient Preference and Adherence 2011, 5:173-180

Published Date: 28 March 2011

Performance of PLS regression coefficients in selecting variables for each response of a multivariate PLS for omics-type data

Giuseppe Palermo, Paolo Piraino, Hans-Dieter Zucht

Advances and Applications in Bioinformatics and Chemistry 2009, 2:57-70

Published Date: 13 May 2009