Cost-effectiveness of switching to biphasic insulin aspart in poorly-controlled type 2 diabetes patients in China
Cost-effectiveness of switching to biphasic insulin aspart in poorly-controlled type 2 diabetes patients in China
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DOI：
10.1007/s12325-008-0080-4
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发表时间：
2008-08-01
影响因子：
3.8
通讯作者：
Valentine, William J.
中科院分区：
文献类型：
--
作者：
Palmer, James L.;Gibbs, Meaghan;Valentine, William J.
简介：2型糖尿病在中国是一个日益严重的问题，但关于药物干预在中国环境中的成本效益的数据很少。方法：以前的数据来自PRESENT（诺和锐30治疗安全性和疗效的医生常规评价），一项多国、单组，双相人胰岛素（BHI）控制不佳的2型糖尿病患者转换为双相门冬胰岛素30（BIAsp 30）的观察性研究;中国亚组的HbA（1c）改善，低血糖事件减少。使用已发表并经验证的糖尿病计算机模拟模型（CORE糖尿病模型）估计中国患者从BHI转为BIAsp 30的长期临床和成本后果。治疗效果和患者特征来源于当前和特定国家的已发表资料。进行了初步研究，以确定患者管理实践和糖尿病相关并发症的成本。模拟并发症的风险来自具有里程碑意义的临床试验和流行病学研究。成本和临床预测是从第三方支付者的角度对患者生命周期进行的，每年贴现3%。广泛的敏感性analysed.Results：转换BIAsp 30从BHI预计将提高贴现预期寿命0.38年每例患者（9.91对9.53年）和质量调整的预期寿命0.91质量调整的生命年（QHMs）每例患者（6.32对5.41 QHMs）。转换为BIAsp 30与每例患者的直接医疗成本增加（CNY）1751元相关，这是由于药房和管理成本增加（CNY +19，007），但被患者生命周期内糖尿病相关并发症成本降低（CNY-17，254）所抵消。结论：BIAsp 30可显著改善临床结局，但增加终生医疗费用。考虑到BHI控制不佳的2型糖尿病患者的支付意愿阈值为每增加QALY CNY 10万元，BIAsp 30在中国被认为具有成本效益。
Introduction: Type 2 diabetes is an increasing problem in China, yet there is a paucity of data regarding the cost-effectiveness of pharmacological interventions in the Chinese setting.Methods: Previous data were obtained from PRESENT (Physicians' Routine Evaluation of Safety and Efficacy of NovoMix 30 Therapy), a multicountry, single-arm, observational study where type 2 diabetes patients poorly controlled with biphasic human insulin (BHI) were converted to biphasic insulin aspart 30 (BIAsp30); the Chinese subgroup experienced an improvement in HbA(1c) and a reduction in hypoglycaemic events. A published and validated computer simulation model of diabetes (the CORE Diabetes Model) was used to estimate the long-term clinical and cost consequences of switching to BIAsp30 from BHI in the Chinese setting. Treatment effects and patient characteristics were derived from PRESENT and countryspecific published sources. Primary research was performed to ascertain patient management practices and diabetes-related complication costs. Risks of modelled complications were derived from landmark clinical trials and epidemiological studies. Costs and clinical projections were made over patient lifetimes from a third-party payer perspective and discounted at 3% annually. Extensive sensitivity analyses were performed.Results: Conversion to BIAsp30 from BHI was projected to improve discounted life expectancy by 0.38 years per patient (9.91 vs 9.53 years) and quality-adjusted life expectancy by 0.91 quality-adjusted life years (QALYs) per patient (6.32 vs 5.41 QALYs). Conversion to BIAsp30 was associated with increased direct medical costs of Chinese Yuan (CNY) 1751 per patient, due to higher pharmacy and management costs (CNY +19,007), offset by reduced diabetes-related complication costs (CNY -17,254) over patient lifetimes. BIAsp30 was associated with an incremental cost-effectiveness ratio of CNY 1926 per QALY gained.Conclusion: BIAsp30 was projected to substantially improve clinical outcomes but was associated with increased lifetime medical costs. BIAsp30 would be considered cost-effective in China given a willingness-to-pay threshold of CNY 100,000 per QALY gained in type 2 diabetes patients poorly controlled on BHI.