Shearer Arran T, Bagust Adrian, Liebl Andreas, Schoeffski Oliver, Goertz Anita
York Health Economics Consortium, University of York, Heslington, UK.
Pharmacoeconomics. 2006;24 Suppl 1:35-48. doi: 10.2165/00019053-200624001-00004.
AIMS/HYPOTHESIS: To assess the cost-effectiveness of rosiglitazone in combination with other oral agents for the treatment of overweight and obese patients with type 2 diabetes in Germany.
The Diabetes Decision Analysis of Cost--type 2 model was adapted for clinical practice and healthcare financing rules in Germany. The model was calibrated using Cost of Diabetes in Europe Type 2 study data and national statistics. The perspective is that of the sickness funds, and includes all hospital inpatient, ambulatory, rehabilitation, and diabetes therapy, other medications, and sickness leave. The model simulates lifetime treatment histories and associated health outcomes and costs for age and sex-matched cohorts of 1000 overweight and obese patients. The measures of effectiveness used in the analysis were life-years and quality adjusted life-years (QALYs).
The combination therapy of rosiglitazone with metformin or sulfonylurea produces better glycaemic control than conventional care of metformin with sulfonylurea and insulin in most patients, extends the viability of oral therapy before requiring insulin, and typically leads to lifetime cost increases across all treatment types. The improvements in glycaemic control lead to survival gains and reductions in morbidity, because of the reduced risk of developing or progressing to later stages of complications. Improvements in morbidity and mortality generate additional QALYs. Costs and health outcomes combine to yield favourable incremental cost-effectiveness ratios, which fall below international 'willingness-to-pay' thresholds in the medium term.
The model predicts that rosiglitazone in combination with other oral agents is a cost-effective intervention for the treatment of normal weight, overweight and obese patients with type 2 diabetes when compared with conventional care in Germany.
目的/假设：评估罗格列酮联合其他口服药物治疗德国超重和肥胖2型糖尿病患者的成本效益。
糖尿病成本-2型决策分析模型根据德国的临床实践和医疗保健筹资规则进行了调整。该模型使用欧洲2型糖尿病成本研究数据和国家统计数据进行了校准。视角为疾病基金，包括所有医院住院、门诊、康复以及糖尿病治疗、其他药物和病假。该模型模拟了1000名超重和肥胖患者年龄和性别匹配队列的终生治疗史以及相关的健康结果和成本。分析中使用的有效性指标为生命年和质量调整生命年（QALY）。
在大多数患者中，罗格列酮与二甲双胍或磺脲类药物联合治疗比二甲双胍与磺脲类药物及胰岛素的传统治疗能更好地控制血糖，在需要胰岛素治疗之前延长了口服治疗的可行性，并且通常会导致所有治疗类型的终生成本增加。血糖控制的改善导致生存率提高和发病率降低，因为发生并发症或进展至并发症后期阶段的风险降低。发病率和死亡率的改善产生了额外的QALY。成本和健康结果相结合产生了有利的增量成本效益比，在中期低于国际“支付意愿”阈值。
该模型预测，与德国的传统治疗相比，罗格列酮联合其他口服药物是治疗正常体重、超重和肥胖2型糖尿病患者的一种具有成本效益的干预措施。
