Cost-effectiveness analysis of exenatide twice daily (BID) vs insulin glargine once daily (QD) as add-on therapy in Chinese patients with Type 2 diabetes mellitus inadequately controlled by oral therapies
Cost-effectiveness analysis of exenatide twice daily (BID) vs insulin glargine once daily (QD) as add-on therapy in Chinese patients with Type 2 diabetes mellitus inadequately controlled by oral therapies
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DOI：
10.3111/13696998.2015.1067622
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发表时间：
2015-11-02
影响因子：
2.4
通讯作者：
Shi, Lizheng
中科院分区：
文献类型：
--
作者：
Deng, Jing;Gu, Shuyan;Shi, Lizheng
目的：评估艾塞那肽每日两次 (BID) 与甘精胰岛素每日一次 (QD) 作为附加治疗对于口服抗糖尿病 (OAD) 药物控制不佳的中国 2 型糖尿病患者的成本效益。 方法：Cardiff 模型填充了中国三项长达 30 周的头对头随机临床试验的数据，比较艾塞那肽 BID 与甘精胰岛素作为中国人群口服治疗的附加疗法。卡迪夫模型生成的输出包括大血管和微血管并发症、糖尿病特异性死亡率、成本和质量调整生命年 (QALY)。从社会角度，以 40 年的时间范围，以 3% 的贴现率估算成本和 QALY。结果：与甘精胰岛素加 OAD 治疗相比，艾塞那肽 BID 加 OAD 治疗的患者获得了 1.88 QALY，增量成本节省人民币 114,593 元（即节省成本 61078 元/QALY）。成本效益结果对于各种敏感性分析（包括概率敏感性分析）来说是稳健的。对增量成本效益比影响最大的变量包括基线 HbA1c 水平、医疗设施减少和基线 BMI。结论：与甘精胰岛素 QD 相比，艾塞那肽 BID 作为 OAD 的附加疗法对于 OAD 治疗控制不充分的中国患者来说是一种经济有效的治疗方法。
Objective:To estimate cost-effectiveness of exenatide twice daily (BID) vs insulin glargine once daily (QD) as add-on therapy in Chinese type 2 diabetes patients not well controlled by oral anti-diabetic (OAD) agents.Methods:The Cardiff model was populated with data synthesized from three head-to-head randomized clinical trials of up to 30 weeks in China comparing exenatide BID vs insulin glargine as add-on therapies to oral therapies in the Chinese population. The Cardiff model generated outputs including macrovascular and microvascular complications, diabetes-specific mortality, costs, and quality-adjusted life years (QALYs). Cost and QALYs were estimated with a time horizon of 40 years at a discount rate of 3% from a societal perspective.Results:Compared with insulin glargine plus OAD treatments, patients on exenatide BID plus OAD gained 1.88 QALYs, at an incremental cost saving of Chinese Renminbi (RMB) 114,593 (i.e., cost saving of RMB 61078/QALY). The cost-effectiveness results were robust to various sensitivity analyses including probabilistic sensitivity analysis. The variables with the most impact on incremental cost-effectiveness ratio included HbA1c level at baseline, health utilities decrement, and BMI at baseline.Conclusions:Compared with insulin glargine QD, exenatide BID as add-on therapy to OAD is a cost-effective treatment in Chinese patients inadequately controlled by OAD treatments.