HealthMetrics Outcomes Research LLC, 120 Anchorage Circle, Groton, Connecticut 06340, USA.
Adv Ther. 2009 Feb;26(2):217-29. doi: 10.1007/s12325-009-0002-0. Epub 2009 Feb 14.
Exenatide (Byetta, Amylin Pharmaceuticals Inc., CA, USA) and sitagliptin (Januvia, Merck & Co, NJ, USA) are two antidiabetic agents recently approved by the US Food and Drug Administration. The purpose of this analysis was to compare costs among patients with type 2 diabetes (T2D) treated with either of these agents.
Data with dates of service from September 1, 2005 through August 31, 2007, were obtained from a large US retrospective claims database. Intent-to-treat cohorts of adults diagnosed with T2D who began taking either exenatide (n=1885) or sitagliptin (n=2482) and did not use the alternate medication in the 6-month follow-up period were created. Six-month total medical costs were estimated using stepwise multivariate regressions. Six-month total diabetes-related medical costs, a component of total medical costs, were also estimated using stepwise multivariate regressions. In addition, other cost components were examined using either stepwise multivariate regressions or a two-part model that controlled for the probability of using the medical service. Smearing estimates were used to transform estimated log costs into costs. The analysis controlled for the potential impact of patient demographics, general health, prior resource use, comorbidities, and timing of treatment initiation.
Exenatide was associated with lower total 6-month direct medical costs ($9340 vs. $9995; P<0.0001), despite some component costs being slightly higher with exenatide: diabetes-related drug costs ($1765 vs. $1743; P=0.0062), diabetes-related medical costs ($4142 vs. $4002; P<0.0001), and emergency room costs ($43 vs. $29; P=0.0388). Exenatide was associated with lower outpatient costs ($4498 vs. $5942; P<0.0001).
Compared with the use of sitagliptin, exenatide was associated with lower total medical costs (difference of $655) despite higher total diabetes-related costs (difference of $140). As a result, there appears to be overall cost savings associated with the use of exenatide relative to sitagliptin.
Exenatide（百泌达，Amylin Pharmaceuticals Inc.，加利福尼亚州，美国）和西他列汀（捷诺维，默克公司，新泽西州，美国）是最近被美国食品和药物管理局批准的两种抗糖尿病药物。本分析的目的是比较接受这两种药物治疗的 2 型糖尿病（T2D）患者的成本。
从美国一个大型回顾性索赔数据库中获取 2005 年 9 月 1 日至 2007 年 8 月 31 日期间的服务日期数据。创建了接受 exenatide（n=1885）或 sitagliptin（n=2482）治疗且在 6 个月随访期间未使用替代药物的 T2D 成年患者意向治疗队列。使用逐步多元回归估计 6 个月的总医疗费用。使用逐步多元回归估计总医疗费用的一个组成部分，即糖尿病相关医疗费用。此外，还使用逐步多元回归或控制医疗服务使用概率的两部分模型来检查其他成本组成部分。使用平滑估计将估计的对数成本转换为成本。该分析控制了患者人口统计学、一般健康状况、既往资源使用、合并症和治疗开始时间的潜在影响。
尽管 exenatide 的某些部分费用略高（糖尿病相关药物费用为 1765 美元 vs. 1743 美元；P=0.0062）、糖尿病相关医疗费用为 4142 美元 vs. 4002 美元；P<0.0001）和急诊费用为 43 美元 vs. 29 美元；P=0.0388），但 exenatide 与较低的 6 个月直接医疗总费用相关（$9340 美元 vs. $9995 美元；P<0.0001）。Exenatide 与较低的门诊费用相关（$4498 美元 vs. $5942 美元；P<0.0001）。
与使用 sitagliptin 相比，尽管 exenatide 的总糖尿病相关费用较高（$140），但与使用 sitagliptin 相比，exenatide 与较低的总医疗费用（$655）相关。因此，与使用 sitagliptin 相比，使用 exenatide 似乎可以节省总体成本。
