Varadhan, Lakshminarayanan, Saravanan, Ponnusamy, Ali, Sarah N., Hanif, Wasim and Patel, Vinod (2022) Informing and empowering patients and clinicians to make evidence-supported outcome-based decisions in relation to SGLT2 inhibitor therapies : the use of the novel Years of Drug administration (YoDa) concept. Clinical Drug Investigation, 42 (2). pp. 113-125. doi:10.1007/s40261-021-01105-7 ISSN 1173-2563.
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Abstract
The American Diabetes Association guidelines for the management of type 2 diabetes mellitus recommends treating patients with atherosclerotic cardiovascular diseases, heart failure or diabetic kidney disease with sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists, irrespective of the baseline HbA1c, to reduce adverse renal and cardiovascular outcomes. Initiation of such therapies have a significant cost impact on health economies. Cost of gain in quality-adjusted life-years is normally used for cost effectiveness for a particular drug. In the absence of head-to-head comparisons, prescribers may go for the cheapest option, which may not necessarily be the right decision. We propose using the calculated ‘YoDa’ (Years of Drug administration) as an easily comparable metric between the drug accrual cost and clinical outcomes. YoDa is calculated as a product of numbers needed to treat and the median duration in years that the trial ran over, to accrue the positive clinical outcomes. Clinical phenotyping of the patient to the specific inclusion and exclusion criteria of relevant clinical trials could guide the clinician to choose the most appropriate therapy. We also propose a series of steps or ‘deliberations’, which a clinician should consider in making a final choice of sodium-glucose co-transporter-2 inhibitor therapy. A comprehensive summary of the sodium-glucose co-transporter-2 inhibitor trials, clinical phenotyping and YoDa calculations for various significant clinical outcomes could assist making evidence-based, patient-individualised and cost-effective management plans for diabetes care.
| Item Type: | Journal Article |
|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
| Journal or Publication Title: | Clinical Drug Investigation |
| Publisher: | Adis Int. Ltd. |
| ISSN: | 1173-2563 |
| Official Date: | 2 February 2022 |
| Dates: | Date Event 2 February 2022 Published 17 November 2021 Accepted |
| Volume: | 42 |
| Number: | 2 |
| Page Range: | pp. 113-125 |
| DOI: | 10.1007/s40261-021-01105-7 |
| Status: | Peer Reviewed |
| Publication Status: | Published |
| Access rights to Published version: | Restricted or Subscription Access |
| Copyright Holders: | © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022 |
| URI: | https://wrap.warwick.ac.uk/163578/ |
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