Cost-effectiveness analysis of insulin, sulfonylurea, and sulfonylurea– Metformin in type 2 diabetes mellitus

Objective: This study aims to compare the cost-effectiveness of insulin therapy, sulfonylureas, and combination of sulfonylureas-metformin in patients with type 2 diabetes mellitus in Sitanala Hospital, Tangerang. Methods: This study employed a cross-sectional to examine the effectiveness and cost of different treatments for Type 2 diabetes mellitus (T2DM) among outpatients at Dr. Sitanala Leprosy Hospital in Tangerang, using cost-effectiveness analysis. Participants had consumed the same drug over the past 4 months and were divided into three groups, as follows: An insulin group (n=29), sulfonylurea group (n=29), and sulfonylurea–metformin combination group (n=39). The effectiveness of treatment was evaluated by considering Hemoglobin A1c (HbA1c) values. The measured cost was direct medical cost. Results: The results showed that there were more female patients (65.96%) than male patients with T2DM, and their average age was 50-59 years. The highest effectiveness was shown in combination in the sulfonylurea–metformin group, with an HbA1c level of 7.48±1.89, although the difference was not statistically significant. The direct medical cost of sulfonylurea monotherapy was significantly lower than that of the other therapies. The average cost-to-effectiveness ratio in the insulin group was Rp. 40,866 that in the sulfonylurea group was Rp. 1,369 and that in the combination of sulfonylurea–metformin group was Rp. 2,621 per percentage of effectivity. The incremental cost-to-effectiveness ratio for the sulfonylurea–metformin to sulfonylurea monotherapy treatment was Rp. 16,194 per percentage effectivity. Conclusion: Based on the analysis performed, sulfonylurea–metformin combination therapy was more cost-effective than either sulfonylurea or insulin monotherapy.