IMS Health, CORE–Center for Outcomes Research GmbH, Gewerbestrasse 25, Allschwil, Switzerland.
J Med Econ. 2010;13(2):212-20. doi: 10.3111/13696991003723999.
To evaluate the cost-effectiveness of switching to biphasic insulin aspart (BIAsp 30) from human premix insulin for type 2 diabetes patients in the United States (US) setting.
The previously published and validated IMS Core Diabetes Model was used to project life expectancy, quality-adjusted life expectancy (QALE) and costs over 30 years. Patient characteristics and treatment effects were based on Canadian patients included the IMPROVE observational study (n = 311). Mean glycohaemoglobin (HbA(1c)) was 8.4%, duration of diabetes 16 years and prevalence of complications high at baseline. Simulations were conducted from the perspective of a third-party payer, with costs accounted in 2008 US dollars ($).
BIAsp 30 was projected to improve life expectancy by 0.202 years and QALE by 0.301 quality-adjusted life-years (QALYs), due to a reduced incidence of most diabetes-related complications. BIAsp 30 was associated with increased lifetime direct medical costs ($76,517 vs. 67,518) and an incremental cost-effectiveness ratio of $29,870 per QALY gained. Long-term outcomes were sensitive to the impact of BIAsp 30 on hypoglycaemia and changes in HbA(1c).
BIAsp 30 may represent a cost-effective treatment option in the US setting for advanced type 2 diabetes patients experiencing poor glycaemic control or hypoglycaemia on human premix insulin.
The application of treatment effect data derived from a Canadian cohort to the US setting was a limitation of the cost-effectiveness analysis. The findings of this cost-effectiveness analysis are not applicable to insulin-naïve diabetes patients.
评估将美国（美国）2 型糖尿病患者的人预混胰岛素转换为双相胰岛素类似物（BIAsp30）的成本效益。
使用先前发表和验证的 IMS Core Diabetes Model 来预测 30 年内的预期寿命、质量调整生命预期（QALE）和成本。患者特征和治疗效果基于包括 IMPROVE 观察性研究（n=311）在内的加拿大患者。平均糖化血红蛋白（HbA1c）为 8.4%，糖尿病病程 16 年，基线时并发症高发。模拟从第三方支付者的角度进行，以 2008 年美元（$）计算成本。
由于大多数糖尿病相关并发症的发病率降低，BIAsp30 预计将使预期寿命延长 0.202 年，使 QALE 延长 0.301 个质量调整生命年（QALY）。BIAsp30 与终生直接医疗费用增加（$76517 比 67518）和每获得一个 QALY 的增量成本效益比为$29870 相关。长期结果对 BIAsp30 对低血糖和 HbA1c 变化的影响敏感。
对于在人预混胰岛素治疗下血糖控制不佳或出现低血糖的晚期 2 型糖尿病患者，BIAsp30 可能代表一种在美国具有成本效益的治疗选择。
将源自加拿大队列的治疗效果数据应用于美国环境是成本效益分析的一个局限性。本成本效益分析的结果不适用于胰岛素初治糖尿病患者。
