The Pharmaceutical Benefits Advisory Committee (PBAC) has used the final report of the Post-market Review of Products used in the Management of Diabetes to ensure that medicines funded by the Pharmaceutical Benefits Scheme (PBS) offer optimal health outcomes, whilst addressing expenditure growth in the treatment of type 2 diabetes from $130 million in 2000 to $501 million in 2013.

Of the three broad groups of triple therapies that combine with metformin and sulfonylurea: SGLT2 inhibitors and GLP-1 receptor agonists were found to cause weight loss, DPP-4 inhibitors were relatively weight neutral or had a small weight gain, and insulin and TZDs resulted in weight gain. Combination therapy of acarbose with metformin and sulfonylurea was found to be a cost effective treatment deserving more consideration, despite 20% of patients being intolerant of the side-effects of acarbose.

Furthermore, it was noted that there is currently insufficient evidence to support the inclusion of most triple therapies into the PBS. The combination of metformin, TZD and DPP-4 inhibitor was shown, however, not to be significantly better than metformin and sulfonylurea dual therapy, whereas the combination of metformin, sulfonylurea and SGLT2 inhibitor demonstrated a significant contribution to weight loss as well as the largest reduction in HbA1c. The PBAC expressed interest in receiving submissions for this combination.

It was also noted that the need for updated guidelines was addressed by the release of: A new blood glucose management algorithm for type 2 diabetes: a position statement of the Australian Diabetes Society.

References:

  1. Gunton JE, Cheung NW, Davis TM, Zoungas S, Colagiuri S; Australian Diabetes Society. A new blood glucose management algorithm for type 2 diabetes: a position statement of the Australian Diabetes Society. Med J Aust. 2014 Dec 11;201(11): 650-3.
  2. Diabetes Review Reference Group. Post-Market Review of Products Used in the Management of Diabetes Part 3: Type 2 Diabetes Medicines. Canberra: Australian Government Department of Health and Ageing; 2014.
  3. Pharmaceutical Benefits Advisory Committee. Ratified PBAC Minutes- November 2014. Canberra: Australian Government Department of Health and Ageing; 2014.

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