Short-Term Cost-Effectiveness of Switching to Insulin Degludec in Japanese Patients With Type 2 Diabetes Receiving Basal-Bolus Therapy
Short-Term Cost-Effectiveness of Switching to Insulin Degludec in Japanese Patients With Type 2 Diabetes Receiving Basal-Bolus Therapy
复制标题
接受基础推注治疗的日本 2 型糖尿病患者改用德谷胰岛素的短期成本效益
DOI：
10.1007/s13300-019-0635-1
复制
发表时间：
2019
期刊：
影响因子：
3.8
通讯作者：
Eiichi Araki 4
中科院分区：
文献类型：
--
作者：
Jakob Langer 1;Michael L Wolden 2;Seiya Shimoda 3;Miki Sato 4;Eiichi Araki 4
日本是世界上人口老龄化最快的国家之一，由于2型糖尿病（T2 D）等与衰老相关的疾病给公共医疗系统带来了巨大负担，人口结构的变化是一个重大的公共卫生问题。本分析旨在评价接受基础-餐时胰岛素治疗的日本T2 D患者从既往基础胰岛素转换为德谷胰岛素的短期成本-效果（degludec）在常规临床实践的条件下进行。在Microsoft Excel中开发的开源模型被用来评估转换基础的成本效益，从日本公共医疗保健支付者的角度，从患者既往基础胰岛素到德谷胰岛素的餐时胰岛素治疗与继续既往基础胰岛素治疗方案的成本（2018日元[JPY]）和质量调整生命年（Qs）。该模型捕获了1年时间范围内的低血糖率和胰岛素剂量，并从熊本德谷胰岛素观察性研究的T2 D队列（N= 135）的日本真实世界证据中获得信息。（+ 0.0354 Qs），由德谷的日间非重度低血糖发生率较低驱动，与继续使用之前的基础胰岛素相比，年治疗费用略高（9510日元）。研究发现，将基础胰岛素转换为德谷胰岛素是一种具有成本效益的干预措施，增量成本效益比（每增加一个QALY 268，811日元）远低于日本卫生技术评估框架中使用的每QALY 500万日元的支付意愿阈值。敏感性分析证实了这一发现的鲁棒性，并表明德谷的日间非严重低血糖的好处是一个关键的驱动程序的结果在basecase.ConclusionBased日本的真实世界的证据，我们的分析表明，开关日本T2 D患者接受基础-餐时胰岛素方案从他们以前的基础胰岛素德谷将具有很高的成本效益。这些数据可以帮助日本的决策者有效地分配医疗资源。试验注册KIDUNA研究已在大学医院医学信息网络临床试验注册处（UMIN-CTR）注册：UMIN 000021569。
IntroductionWith one of the fastest aging populations in the world, demographic changes in Japan are a major public health concern due to the substantial burden that aging-associated diseases, such as type 2 diabetes (T2D), place on public healthcare systems. The aim of this analysis was to evaluate the short-term cost-effectiveness of switching Japanese patients with T2D receiving basal–bolus insulin therapy from their previous basal insulin to insulin degludec (degludec) under conditions of routine clinical practice.MethodsA previously published, open-source model developed in Microsoft Excel was used to evaluate the cost-effectiveness of switching basal–bolus insulin therapy from patients' previous basal insulin to degludec versus continuing the previous basal insulin therapeutic regimen in terms of costs (2018 Japanese Yen [JPY]) and quality-adjusted life years (QALYs), from a Japanese public healthcare payer perspective. The model captured hypoglycemia rates and insulin dosing over a 1-year time horizon, and was informed by Japanese real-world evidence from the T2D cohort (N= 135) of the Kumamoto Insulin Degludec Observational study.ResultsTreatment with degludec was associated with improved effectiveness (+ 0.0354 QALYs), driven by lower daytime non-severe hypoglycemia rates with degludec, at slightly higher annual treatment costs (JPY 9510) versus continuing the previous basal insulin. Switching basal insulin to degludec was found to be a cost-effective intervention with an incremental cost-effectiveness ratio (JPY 268,811 per QALY gained) substantially below the willingness-to-pay threshold of 5 million JPY per QALY used in the Japanese Health Technology Assessment framework. Sensitivity analyses confirmed the robustness of this finding and indicated that the daytime non-severe hypoglycemia benefit with degludec was a key driver of outcomes in the base case.ConclusionBased on Japanese real-world evidence, our analysis suggests that switching Japanese patients with T2D receiving a basal–bolus regimen from their previous basal insulin to degludec would be highly cost-effective. These data may help decision-makers in Japan allocate healthcare resources efficiently.Trial RegistrationThe KIDUNA study is registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR): UMIN000021569.FundingNovo Nordisk Pharma Ltd. Japan.