Center for Health Economics, Gottfried Wilhelm Leibniz University, Hannover, Germany.
Diabetes Obes Metab. 2009 Nov;11(11):1068-79. doi: 10.1111/j.1463-1326.2009.01099.x. Epub 2009 Sep 3.
The objective of this analysis was to determine the cost-effectiveness of exenatide vs. insulin glargine in patients with type 2 diabetes failing to achieve glycaemic control with oral antidiabetic agents, in the German setting, from a third-party payer perspective.
Data from a published randomized controlled trial were used in combination with a published, validated computer simulation model of type 2 diabetes to project clinical and cost outcomes over a time horizon of 10 years. Cost data were obtained from published literature and expert opinion. Clinical and cost outcomes were discounted at 5% per annum. Sensitivity analyses were performed to establish key drivers and parameters.
Treatment with exenatide compared with insulin glargine was projected to be associated with improvements in life expectancy of 0.016 years and quality-adjusted life expectancy of 0.280 quality-adjusted life years (QALYs), increased lifetime direct medical costs of euro 3854 (euro 22 095 vs. euro 18 242) and an incremental cost-effectiveness ratio (ICER) of euro 13 746 per QALY. If quality of life was not taken into account, exenatide was associated with an ICER of euro 238 201 per life year gained vs. insulin glargine. Sensitivity analyses revealed that outcomes were most sensitive to changes in assumptions for (dis)utility values relating to weight change and the rate of self-monitored blood glucose testing.
Exenatide was projected to be associated with similar clinical outcomes and increased costs compared with insulin glargine. Analysis of cost-effectiveness from a third-party perspective suggests that exenatide is likely to represent good value for money in the German setting.
本分析旨在从第三方支付者的角度出发，评估在德国，对于口服降糖药治疗血糖控制不佳的 2 型糖尿病患者，艾塞那肽对比甘精胰岛素的成本效果。
使用已发表的随机对照试验数据，并结合已发表的、经过验证的 2 型糖尿病计算机模拟模型，预测 10 年时间内的临床和成本结果。成本数据来自已发表的文献和专家意见。临床和成本结果均以每年 5%的贴现率贴现。进行敏感性分析以确定关键驱动因素和参数。
与甘精胰岛素相比，使用艾塞那肽治疗预计可使预期寿命延长 0.016 年，使质量调整后的预期寿命延长 0.280 个质量调整生命年（QALY），使终生直接医疗费用增加 3854 欧元（3854 欧元比 18242 欧元），增量成本效果比（ICER）为每 QALY 增加 13746 欧元。如果不考虑生活质量，与甘精胰岛素相比，艾塞那肽与每获得一个生命年增加的 ICER 为 238201 欧元。敏感性分析表明，结果对与体重变化和自我监测血糖测试率相关的（不）效用值的假设变化最为敏感。
与甘精胰岛素相比，艾塞那肽预计会有相似的临床结果和更高的成本。从第三方角度分析成本效果表明，在德国，艾塞那肽可能具有良好的性价比。
