Ossian Health Economics and Communications, Basel, Switzerland.
Curr Med Res Opin. 2010 Jun;26(6):1399-412. doi: 10.1185/03007991003689381.
To review the cost-effectiveness of biphasic insulin aspart (BIAsp 30) compared to other insulin regimens in the treatment of type 2 diabetes based on published literature.
The electronic databases MEDLINE, EMBASE, the Cochrane Library and EconLit and a selection of congress/meeting databases were systematically searched using combinations of search terms designed to identify publications describing cost-effectiveness analyses of BIAsp 30 in patients with type 2 diabetes. Searches were limited to studies in humans, and published in the English language between January 1999 and July 2009. All records were screened for inclusion in the review.
Seven published cost-effectiveness analyses and ten abstracts were identified. One was a health technology assessment from the UK, which evaluated cost-effectiveness using the UKPDS Outcomes Model and meta-analysis of published clinical trials and concluded that premixed insulin analogs were unlikely to be cost-effective versus insulin glargine or biphasic human insulin. In all other studies the cost-effectiveness of BIAsp 30 versus other insulin regimens was assessed using the validated CORE Diabetes Model and outcomes from either the INITIATE randomized controlled trial, or the PRESENT or IMPROVE observational studies. However, notable limitations include the fact that all cost-effectiveness analyses to date have been performed using a single model and that a number of these are based on data from observational studies rather than randomized controlled trials. Nevertheless, long-term clinical and economic outcomes were reported for several countries: UK, US, Sweden, Saudi Arabia, Poland, South Africa, South Korea and China. BIAsp 30 was associated with improvements in quality-adjusted life expectancy in all countries. Estimates of direct costs varied according to country and comparator, but incremental cost-effectiveness ratios for the US and UK were USD 46 533 and GBP 6951 per quality-adjusted life year gained for BIAsp 30 versus insulin glargine.
Although cost-effectiveness data on BIAsp 30 are scarce the majority of the analyses identified in this review suggest that BIAsp 30 is likely to be cost-effective compared to insulin glargine and biphasic human insulin across a wide range of settings, and under certain circumstances would be a dominant treatment option.
根据已发表的文献，综述双相门冬胰岛素（BIAsp 30）与其他胰岛素方案治疗 2 型糖尿病的成本效果。
系统检索电子数据库 MEDLINE、EMBASE、Cochrane 图书馆和 EconLit 以及部分会议/会议数据库，使用旨在确定描述 2 型糖尿病患者 BIAsp 30 成本效果分析的出版物的检索词组合进行检索。检索仅限于人类研究，并限定于 1999 年 1 月至 2009 年 7 月期间以英文发表的文献。所有记录都经过筛选，以纳入综述。
共确定了 7 篇已发表的成本效果分析和 10 篇摘要。其中一项是来自英国的卫生技术评估，使用 UKPDS 结果模型和已发表临床试验的荟萃分析评估成本效果，结论是预混胰岛素类似物与甘精胰岛素或人胰岛素双相相比不太可能具有成本效果。在所有其他研究中，使用经过验证的 CORE 糖尿病模型和 INITIATE 随机对照试验或 PRESENT 或 IMPROVE 观察性研究的结果评估了 BIAsp 30 与其他胰岛素方案的成本效果。然而，值得注意的局限性包括迄今为止所有的成本效果分析都是使用单一模型进行的，并且其中一些是基于观察性研究而不是随机对照试验的数据。尽管如此，仍有几个国家报告了长期的临床和经济结果：英国、美国、瑞典、沙特阿拉伯、波兰、南非、韩国和中国。在所有国家，BIAsp 30 都与生活质量调整预期寿命的改善有关。直接成本的估计因国家和比较者而异，但美国和英国的增量成本效果比为每获得一个质量调整生命年，BIAsp 30 比甘精胰岛素分别高出 46533 美元和 6951 英镑。
尽管 BIAsp 30 的成本效果数据有限，但本综述中确定的大多数分析表明，BIAsp 30 与甘精胰岛素和人胰岛素双相比，在广泛的环境下可能具有成本效果，在某些情况下，它将是一种主导的治疗选择。
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