Cost-effectiveness analysis of combined antidiabetic therapy for type 2 diabetes mellitus in a tertiary health institution in north-central Nigeria


Abstract Background: Anti-diabetic therapy is a lifetime treatment for patients suffering from diabetes mellitus. This translates into a substantial cost in drug therapy to patients who pay out of pocket, most especially in developing counties.As a result, it will be beneficial to identify competing options in drug therapy in order to redirect resources with the aim of achieving more in terms of cost-effectiveness. Objective: to assess the cost-effectiveness of combined antidiabetic regimens in patients with type 2 diabetes mellitus (T2DM) in University of Ilorin, Teaching Hospital, Ilorin, Kwara state, North- central Nigeria. Method: A sample size of 276 casenotes from the total population was obtained after addition of a 5% attrition rate. A drug utilization study was then conducted through a one year retrospective review (January 2021 to December 2021) of the276 case notesThe casenotes were selected by systematic random sampling using sampling interval of 5. This was accompanied by using the World Health Organization-defined daily dose method of evaluating drug use. TheEuroQoltool (EQ5D) was employed to evaluate the effectiveness of the identified treatment options in terms of quality adjusted life years (QALYs). Results: Combinations of Metformin/Glimepiride, Metformin/Linagliptin, and Metformin/Pioglitazone were identified anti-diabetic therapy options, with utilization patterns of 64.49%, 18.84%, and 16.67 %, respectively, and effectiveness of 0.755, 0.793, and 0.819 QALYs. Metformin/Linagliptin compared with Metformin/Glimepiride caused an incremental cost-effectiveness ratio ( ICER) of 823.16 USD/QALYs which is < GDP/capita of Nigeria ( $2, 097). Showing that Metformin/Linagliptin was more cost-effective. Metformin/ Pioglitazone was dominant when compared with Metformin/Glimepiride, giving an ICER of -25.78 USD/QALYs, also showing that Metformin/ Pioglitazone was more cost effective. All ICERs achieved were robust to input parameter variation on sensitivity analysis.



Antidiabetics, Cost-effectiveness, Diabetes mellitus, Nigeria.


Giwa H.B., Giwa A., Jamiu M.O., Nasiru S., Sa’adu R.A., Abolarin B. (2022): Cost- Effectiveness of Combined Anti-Diabetic Therapy for Type 2 Diabetes Mellitus in a Tertiary Health Institution in North-Central Nigeria. Nigerian Journal of Pharmaceutical and Biomedical Research. 6 (1); 184-195, Published by Faculty of Pharmacy, University of Maiduguri. Available online at>pharmacy