About the PhD thesis

There has been a paradigm shift in treatment of type 2 diabetes (T2D). The 2018 consensus report by ADA/EASD recommended tailoring treatments to individual risk factors, emphasizing SGLT2 inhibitors and GLP-1 receptor agonists, and recently they are being recommended, and used, as first-line treatment for patients with appropriate risk factors. While these newer drugs offer benefits in managing blood glucose, cardiovascular and renal diseases, and weight loss, they are significantly more expensive than older medications like metformin. In resource-limited healthcare systems, funding these treatments may divert resources from other areas.

Cost-effectiveness analyses (CEAs) using decision-analytical models (DAMs) assess the value for money by comparing their long-term costs and effects of alternative treatments. However, these models often rely on assumptions that may not reflect real-world practice. This thesis systematically reviews the methods, parameters, and assumptions used in CEAs with DAMs and compares them with actual clinical practice using nationwide Danish registry data.

The findings indicate that many assumptions in existing CEAs do not align with current treatment pathways, potentially misleading decision-makers about the cost-effectiveness of newer T2D treatments. By evaluating treatment patterns and time to insulin initiation for patients using DPP4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors as second-line therapies, the thesis aims to highlight flaws in economic models with the purpose of improving their accuracy. Aligning models with real-world data will help ensure that decision-makers are better informed when allocating healthcare resources, enhancing the efficiency of T2D management.