Assessing the cost-effectiveness of sodium-glucose cotransporter-2 inhibitors in type 2 diabetes mellitus: A comprehensive economic evaluation using clinical trial and real-world evidence
Assessing the cost-effectiveness of sodium-glucose cotransporter-2 inhibitors in type 2 diabetes mellitus: A comprehensive economic evaluation using clinical trial and real-world evidence
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DOI：
10.1111/dom.14162
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发表时间：
2020-09-02
影响因子：
5.8
通讯作者：
Kosiborod, Mikhail
中科院分区：
文献类型：
--
作者：
McEwan, Phil;Bennett, Hayley;Kosiborod, Mikhail
目的糖尿病的经济负担是由血管并发症的管理驱动的。在随机临床试验中，钠-葡萄糖协同转运体-2抑制剂(SGLT2i)显示了心血管和肾脏并发症的减少，包括因心力衰竭(HHF)和肾脏疾病进展而住院。这项研究的目的是评估SGLT2i类与2型糖尿病(T2 DM)护理标准的成本效益，使用来自临床试验和现实世界研究的证据。方法利用SGLT2i的真实研究和随机对照试验评估的当代结果证据，对已建立的T2 DM模型进行调整，并对HHF、心肌梗死、中风、终末期肾病和全因死亡率进行终生外推。这项经济分析考虑了患有和不患有心血管疾病的成年T2 DM患者，从英国、美国和中国的医疗保健支付者的角度进行了终生调查，按国家具体费率打折。结果SGLT2i持续与治疗费用增加、并发症费用减少以及因预期寿命、心血管和微血管发病率以及体重减轻的差异而导致的质量调整寿命年的增加有关。据估计，在英国、美国和中国的总体人口中，SGLT2i在相关门槛下是节省成本或成本效益的，在高风险亚组中成本效益最高。结论研究结果强调，在考虑糖尿病药物的成本时，需要考虑减少常见的、病态的和可预防的T2 DM并发症所节省的成本。
Aims The economic burden of diabetes is driven by the management of vascular complications. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated reductions in cardiovascular and renal complications, including hospitalization for heart failure (HHF) and renal disease progression, in randomized clinical trials. The objective of this study was to evaluate the cost-effectiveness of the SGLT2i class versus standard of care in type 2 diabetes mellitus (T2DM), using evidence from both clinical trial and real-world studies. Methods An established T2DM model was adapted to use contemporary outcomes evidence from real-world studies and randomized controlled trial evaluations of SGLT2i, and extrapolated over a lifetime for HHF, myocardial infarction, stroke, end-stage renal disease and all-cause mortality. The economic analysis considered adults with T2DM, with and without established cardiovascular disease, and was conducted over a lifetime from the perspective of the health care payer in the United Kingdom, United States and China, discounted at country-specific rates. Results SGLT2i were consistently associated with increased treatment costs, reduced complication costs and gains in quality-adjusted life years driven by differences in projected life expectancy, cardiovascular and microvascular morbidity and weight loss. SGLT2i were estimated to be cost-saving or cost-effective at relevant thresholds for the overall population in the United Kingdom, United States and China, with cost-effectiveness being the greatest in higher risk subgroups. Conclusions The findings highlight the need to take into account cost savings from reducing common, morbid and preventable T2DM complications when considering the cost of diabetes medications.