Bullano Michael F, Al-Zakwani Ibrahim S, Fisher Maxine D, Menditto Laura, Willey Vincent J
HealthCore, Inc., Wilmington, DE 19801, USA.
Curr Med Res Opin. 2005 Feb;21(2):291-8. doi: 10.1185/030079905X26234.
To compare hypoglycemia event rates in patients initiated on long-acting insulin analog (glargine) or intermediate-acting insulin (NPH) and to analyze the associated cost-consequence from a managed care perspective.
A retrospective analysis of pharmacy and medical claims and electronic laboratory result data using a southeastern United States managed care health plan.
Patients newly initiated on glargine or NPH between July 1, 2000 and August 31, 2002 were included. Hypoglycemia events were identified from medical claims by their ICD-9CM codes. Multivariable techniques were used to compare hypoglycemia event rates between cohorts.
A total of 1434 patients were eligible (glargine = 310, NPH = 1124). The mean age was 53 years +/- 17 years and 51% of patients were male. The mean treatment duration was 8.6 months +/- 4.5 months. Multivariate analyses showed that patients in the NPH group had a higher hypoglycemia event rate than the glargine group (18.3 versus 7.3 per 100 patients per year; p = 0.009). The number needed to treat (glargine versus NPH) to avoid one hypoglycemia event per patient per year was nine patients at an A1C of 7%. The mean annual index medication cost was $47 more for glargine ($390) than for NPH ($343) per patient per year (p = 0.042). The mean cost per hypoglycemia event was $1087 (95% CI: $764-$1409).
Patients treated with glargine had significantly lower hypoglycemia event rates compared to the NPH group. The risk difference indicated that one hypoglycemia event would be avoided for every nine patients treated with glargine instead of NPH. The cost increase associated with treating nine patients with glargine rather than NPH is less than the cost of treating one hypoglycemia event. In this population, the savings associated with reduced hypoglycemic events more than offset the increased acquisition cost associated with glargine.
比较起始使用长效胰岛素类似物（甘精胰岛素）或中效胰岛素（中性鱼精蛋白锌胰岛素）的患者低血糖事件发生率，并从管理式医疗角度分析相关成本效益。
使用美国东南部管理式医疗健康计划对药房和医疗理赔以及电子实验室结果数据进行回顾性分析。
纳入2000年7月1日至2002年8月31日期间新起始使用甘精胰岛素或中性鱼精蛋白锌胰岛素的患者。通过国际疾病分类第九版临床修订本（ICD - 9CM）编码从医疗理赔中识别低血糖事件。采用多变量技术比较队列之间的低血糖事件发生率。
共有1434例患者符合条件（甘精胰岛素组 = 310例，中性鱼精蛋白锌胰岛素组 = 1124例）。平均年龄为53岁±17岁，51%的患者为男性。平均治疗时长为8.6个月±4.5个月。多变量分析显示，中性鱼精蛋白锌胰岛素组患者的低血糖事件发生率高于甘精胰岛素组（每年每100例患者中分别为18.3例和7.3例；p = 0.009）。在糖化血红蛋白（A1C）为7%时，为避免每年每例患者发生一次低血糖事件所需治疗的患者数量（甘精胰岛素组与中性鱼精蛋白锌胰岛素组相比）为9例。甘精胰岛素组每位患者每年的平均索引药物成本比中性鱼精蛋白锌胰岛素组高47美元（分别为390美元和343美元；p = 0. .042）。每次低血糖事件的平均成本为1087美元（95%置信区间：764美元 - 1409美元）。
与中性鱼精蛋白锌胰岛素组相比，使用甘精胰岛素治疗的患者低血糖事件发生率显著更低。风险差异表明，每9例接受甘精胰岛素而非中性鱼精蛋白锌胰岛素治疗的患者可避免发生一次低血糖事件。用甘精胰岛素而非中性鱼精蛋白锌胰岛素治疗9例患者所增加的成本低于治疗一次低血糖事件的成本。在该人群中，与低血糖事件减少相关的节省超过了与甘精胰岛素相关的采购成本增加。
