Cost-utility analysis of intensive blood glucose control with metformin versus usual care in overweight type 2 diabetes mellitus patients in Beijing, P.R. China
Cost-utility analysis of intensive blood glucose control with metformin versus usual care in overweight type 2 diabetes mellitus patients in Beijing, P.R. China
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DOI：
10.1111/j.1524-4733.2008.00363.x
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发表时间：
2008-03-01
期刊：
影响因子：
4.5
通讯作者：
Vondeling, Hindrik
中科院分区：
文献类型：
--
作者：
Xie, Xuanqian;Vondeling, Hindrik
目的：UKPDS 34和51表明，在英国超重的2型糖尿病患者中，二甲双胍强化血糖控制节省了成本，并延长了患者的预期寿命。糖尿病正在成为城市中国的一个重要健康问题。本研究探讨在此背景下，强化血糖控制的效果和成本，旨在为稀缺资源的分配提供决策支持。方法：建立决策分析模型，以符合临床实际的方式，估算北京地区超重2型糖尿病患者强化血糖控制的成本和效果。结果：基础病例分析(3%折现率)显示，二甲双胍强化治疗11年的平均增量成本为126.6 K元(16.4K美元)/质量调整生命年。增量成本-效果比对强化治疗组二甲双胍替代用药的费用和使用的贴现率敏感(0%：105.6 K元/QALY(13.7K美元)；5%：171.0 K元/QALY(22.2K美元))。经过20年和30年(终生)的随访，ICER变得越来越有利，分别为90.1K元(11.7K美元)和74.3K元(9.6K美元)。ICER对强化治疗组二甲双胍替代药物的费用和折扣率最为敏感。结论：对这些结果的解释取决于中国患者为QALY付费的最大意愿，这一点尚未得到正式定义。如果这将是人均国内生产总值的三倍(文献中提出的值)，终身强化血糖控制很可能是划算的。我们的发现不同于英国PDS的研究，并强调在各国推广研究结果需要相当大的适应当地的背景。
Objective: The UKPDS 34 and 51 showed that intensive blood glucose control with metformin is cost-saving and increases life expectancy in overweight type 2 diabetic patients in the United Kingdom. Diabetes is becoming an important health problem in urban China. This study addresses the effects and costs of intensive blood glucose control in this setting, aimed at supporting decision-making on the allocation of scarce resources.Methods: A decision analytic model was developed to estimate the costs and effectiveness of intensive blood glucose control in overweight type 2 diabetes patients in Beijing, compared with usual care in accordance with clinical practice. The analysis was carried out from a health-care perspective.Results: The base-case analysis (3% discount rate) shows that the average incremental costs of 11 years of intensive treatment with metformin are 126.6 K RMB (16.4 K US$) per quality-adjusted life year (QALY) gained. The incremental cost-effectiveness ratio (ICER) is sensitive to the costs of medication alternatives for metformin in the intensive treatment group and to the discount rate used (0%: 105.6 K RMB (13.7 K US$) per QALY gained; 5%: 171.0 K RMB (22.2 K US$) per QALY gained). After 20 and 30 years (lifetime) follow-up, the ICERs become increasingly favorable, 90.1 K RMB (11.7 K US$) and 74.3 K RMB (9.6 K US$), respectively. The ICER is most sensitive to the costs of medication alternatives for metformin in the intensive treatment group, and to the discount rate.Conclusions: Interpretation of the findings depends on the maximum willingness to pay for a QALY in China, which has not officially been defined. If this would be three times the gross domestic product per capita, a value that has been suggested in the literature, lifetime intensive blood glucose control is likely to be cost-effective. Our findings differ from the UKPDS studies and emphasize that generalizing the results of studies across countries requires considerable adaptation to the local context.