Roze Stéphane, Valentine William J, Evers Thomas, Palmer Andrew J
CORE - Center for Outcomes Research, Binningen, Switzerland.
Curr Med Res Opin. 2006 Jul;22(7):1415-24. doi: 10.1185/030079906X115531.
A recent retrospective meta-analysis of cardiovascular events from long-term studies with acarbose in type 2 diabetes showed that treatment was associated with a significant reduction in the risk of cardiovascular events, supporting the hypothesis that postprandial hyperglycemia is a risk factor for cardiovascular disease. The aim of the present study was to assess the cost-effectiveness of acarbose, given in addition to existing treatments, in type 2 diabetes patients, based on these findings, in the German setting.
The CORE Diabetes Model, a published, validated computer simulation model, was used to project long-term clinical and cost outcomes in type 2 diabetes patients receiving acarbose or placebo in addition to existing treatments. Direct costs were retrieved from published sources and projected over patient lifetimes from a third party payer perspective. Costs and clinical benefits were discounted at 5% annually. Extensive sensitivity analyses were performed.
Acarbose treatment was associated with improvements in discounted life expectancy (0.21 years) and quality-adjusted life expectancy (QALE) (0.19 QALYs) but was on average marginally more expensive than treatment in the placebo arm (euro135 per patient). This led to incremental cost-effectiveness ratios of euro633 per life year and euro692 per quality-adjusted life year gained. Sensitivity analysis showed that these findings were robust under variation in a range of assumptions.
Addition of acarbose to existing treatment was associated with improvements in life expectancy and quality-adjusted life expectancy, and provides excellent value for money over patient lifetimes in the German setting.
最近一项对2型糖尿病患者使用阿卡波糖的长期研究进行的回顾性荟萃分析表明，该治疗与心血管事件风险的显著降低相关，支持了餐后高血糖是心血管疾病危险因素这一假说。本研究的目的是基于这些发现，在德国的背景下，评估在2型糖尿病患者中，在现有治疗基础上加用阿卡波糖的成本效益。
使用已发表并经验证的计算机模拟模型CORE糖尿病模型，对在现有治疗基础上接受阿卡波糖或安慰剂治疗的2型糖尿病患者的长期临床和成本结局进行预测。直接成本从已发表的资料中获取，并从第三方支付者的角度预测患者的一生。成本和临床效益按每年5%进行贴现。进行了广泛的敏感性分析。
阿卡波糖治疗与贴现预期寿命（0.21年）和质量调整预期寿命（QALE）（0.19个质量调整生命年）的改善相关，但平均而言，其成本略高于安慰剂组治疗（每位患者135欧元）。这导致每获得一个生命年的增量成本效益比为633欧元，每获得一个质量调整生命年的增量成本效益比为692欧元。敏感性分析表明，在一系列假设的变化下，这些发现是稳健的。
在现有治疗基础上加用阿卡波糖与预期寿命和质量调整预期寿命的改善相关，并且在德国的背景下，在患者的一生中提供了优异的性价比。
