Lifetime cost-effectiveness simulation of once-weekly exenatide in type 2 diabetes: A cost-utility analysis based on the EXSCEL trial

Diabetes Research and Clinical PracticeBecker F, Dakin HA, Reed SD, et al. | November 24, 2021


Once-weekly exenatide (EQW) added to usual care for treating type 2 diabetes led to increased quality-adjusted life-years (QALYs) and costs than usual care alone, in a lifetime extrapolation. The base-case incremental cost-effectiveness ratios (ICERs) were greater than the commonly-cited cost-effectiveness thresholds of $100,000/QALY and £20,000/QALY. However, considerably lower ICERs were noted in some subgroups, and in sensitivity analyses.

  • In the EXSCEL (Exenatide Study of Cardiovascular Event Lowering) trial, EQW vs placebo, added to usual care, was evaluated in 14,752 patients with type 2 diabetes mellitus.

  • In this analysis, the lifetime cost-effectiveness of adding EQW compared with usual care alone was evaluated from a healthcare perspective.

  • In a US setting, 0.162 QALYs were gained with EQW plus usual care at an additional cost of $41,545/patient, vs usual care.

  • The ICER was estimated to be $259,223/QALY.

  • In a UK setting, 0.151 QALYs were gained at an additional cost of £6357, providing an ICER of £42,589/QALY.

  • Sensitivity analyses ranged between $34,369-$269,571 and £3,430-£46,560 per QALY gained.

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