Mesenchymal stromal cell therapy compared to SGLT2-inhibitors and usual care in treating diabetic kidney disease: A cost-effectiveness analysis.
Mesenchymal stromal cell therapy compared to SGLT2-inhibitors and usual care in treating diabetic kidney disease: A cost-effectiveness analysis.
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DOI：
10.1371/journal.pone.0274136
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
O'Neill, Ciaran
中科院分区：
文献类型：
--
作者：
Barry, Luke E.;Crealey, Grainne E.;Cockwell, Paul;Elliman, Stephen J.;Griffin, Matthew D.;Maxwell, Alexander P.;O'Brien, Timothy;Perico, Norberto;O'Neill, Ciaran
模拟间充质基质细胞（MSC）治疗与钠/葡萄糖协同转运蛋白2抑制剂（SGLT 2 i）或常规护理（UC）相比治疗糖尿病肾病（DKD）患者的成本效益。该马尔可夫链蒙特卡罗模型采用了社会视角，并使用终身范围模拟了10，000名符合MSC治疗和UC的DKD患者。将该队列与SGLT 2 i联合UC组和仅UC组进行比较。模型输入数据提取自文献。使用了每质量调整生命年47，000美元的阈值和3%的贴现率。主要结果指标是增量净货币效益（INMB）。进行敏感性分析以检查：参数不确定性; MSC有效性和成本的阈值效应;以及根据患者年龄（71岁vs 40岁）、性别和管辖区（英国、意大利和爱尔兰）的INMB。虽然MSC比UC更具成本效益，但UC和MSC组均以SLGT 2 i为主。相对于SGLT 2 i，MSC和UC的INMB分别为-4，158美元和-10，085美元，表明SGLT 2 i、MSC和UC在给定阈值下具有成本效益的概率分别为64%、34%和1%。这种模式在大多数情况下是一致的;由SGLT 2 i相对较低的成本驱动，并在延迟肾衰竭和全因死亡方面表现出类效应。当在基线时检查年轻患者时，SGLT 2 i仍然是最具成本效益的，但MSC对UC的治疗效果更好，因为延迟进展为ESRD的终身获益增加。关于MSC治疗有效性的证据基础继续发展。这些治疗逆转肾损伤的潜力将大大改善其成本效益，因为这些治疗针对年轻患者和/或SGLT 2 i禁忌症患者。
To simulate the cost-effectiveness of Mesenchymal Stromal Cell (MSC) therapy compared to sodium/glucose co-transporter 2 inhibitors (SGLT2i) or usual care (UC) in treating patients with Diabetic Kidney Disease (DKD). This Markov-chain Monte Carlo model adopted a societal perspective and simulated 10,000 patients with DKD eligible for MSC therapy alongside UC using a lifetime horizon. This cohort was compared with an SGLT2i alongside UC arm and a UC only arm. Model input data were extracted from the literature. A threshold of $47,000 per quality-adjusted life year and a discount rate of 3% were used. The primary outcome measure was incremental net monetary benefit (INMB). Sensitivity analysis was conducted to examine: parameter uncertainty; threshold effects regarding MSC effectiveness and cost; and INMB according to patient age (71 vs 40 years), sex, and jurisdiction (UK, Italy and Ireland). While MSC was more cost-effective than UC, both the UC and MSC arms were dominated by SLGT2i. Relative to SGLT2i, the INMB’s for MSC and UC were -$4,158 and -$10,085 respectively indicating that SGLT2i, MSC and UC had a 64%, 34% and 1% probability of being cost-effective at the given threshold, respectively. This pattern was consistent across most scenarios; driven by the relatively low cost of SGLT2i and demonstrated class-effect in delaying kidney failure and all-cause mortality. When examining younger patients at baseline, SGLT2i was still the most cost-effective but MSC performed better against UC given the increased lifetime benefit from delaying progression to ESRD. The evidence base regarding the effectiveness of MSC therapy continues to evolve. The potential for these therapies to reverse kidney damage would see large improvements in their cost-effectiveness as would targeting such therapies at younger patients and/or those for whom SGLT2i is contra-indicated.
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影响因子：
4.4
作者：
Husereau, Don;Drummond, Michael;Augustovski, Federico;de Bekker-Grob, Esther;Briggs, Andrew H;Carswell, Chris;Caulley, Lisa;Chaiyakunapruk, Nathorn;Greenberg, Dan;Loder, Elizabeth;Mauskopf, Josephine;Mullins, C Daniel;Petrou, Stavros;Pwu, Raoh-Fang;Staniszewska, Sophie
通讯作者：
Staniszewska, Sophie
影响因子：
11.1
作者：
Packham, David K.;Fraser, Ian R.;Kerr, Peter G.;Segal, Karen R.
通讯作者：
Segal, Karen R.
影响因子：
2.5
作者：
de Vries, Eline F.;Rabelink, Ton J.;van den Hout, Wilbert B.
通讯作者：
van den Hout, Wilbert B.
影响因子：
158.5
作者：
Perkovic, V.;Jardine, M. J.;Bentley-Lewis, Rhonda
通讯作者：
Bentley-Lewis, Rhonda
影响因子：
3.2
作者：
Robinson, Lisa A.;Hammitt, James K.;Resch, Stephen
通讯作者：
Resch, Stephen