在中国 2 型糖尿病患者中，双相门冬胰岛素与甘精胰岛素的成本效果比较。

Cost-effectiveness of biphasic insulin aspart versus insulin glargine in patients with type 2 diabetes in China.

机构信息

IMS Health, Basel, Switzerland.

出版信息

Adv Ther. 2010 Nov;27(11):814-27. doi: 10.1007/s12325-010-0078-6. Epub 2010 Oct 12.

DOI:10.1007/s12325-010-0078-6

PMID:21061114

Abstract

BACKGROUND

The OnceMix and INITIATE studies have indicated that biphasic insulin aspart 30 (BIAsp 30) is more effective than insulin glargine (IGlarg), in terms of glycohemoglobin reductions, in patients with type 2 diabetes initiating insulin therapy. The cost-effectiveness of BIAsp 30 versus IGlarg in the Chinese setting is estimated here.

METHODS

The validated and peer-reviewed CORE Diabetes Model was used. The nephropathy, retinopathy, and stroke submodels were modified to incorporate available Chinese clinical data. Diabetes complication costs were derived from hospital surveys in Beijing and Chengdu. Simulated cohorts and insulin treatment effects were based on the OnceMix study for once-daily BIAsp 30 versus IGlarg and on the INITIATE study for twice-daily BIAsp 30 versus IGlarg. Life expectancy and direct medical costs were calculated. Projections were made over 30-year time horizons, with costs and life years discounted at 3% annually. Extensive sensitivity analyses were performed, including adjustments to cardiovascular risk for Chinese ethnicity.

RESULTS

Once-daily BIAsp 30 increased life expectancy by 0.04 years (12.37 vs. 12.33 years) and reduced direct medical costs by Chinese Yuan (CNY) 59,710 per patient (CNY 229,911 vs. CNY 289,621 per patient) compared with IGlarg in the OnceMix-based analysis. Twice-daily BIAsp 30 increased life expectancy by 0.08 years (12.99 vs. 12.91 years) and reduced direct medical costs by CNY 107,349 per patient (CNY 303,142 vs. CNY 410,491 per patient) compared with IGlarg in the INITIATE-based analysis. Improvements in life expectancy were driven by reduced incidences of most diabetes-related complications. Cost savings were attributable to lower lifetime insulin costs for BIAsp 30 compared with IGlarg in China. Lowered cardiovascular risk for Chinese ethnicity reduced the projected clinical improvements for BIAsp 30 but increased treatment-related lifetime cost savings.

CONCLUSIONS

BIAsp 30, either once- or twice-daily, improved projected life expectancy and reduced projected costs compared with IGlarg in the Chinese setting.

摘要

背景

OnceMix 和 INITIATE 研究表明，对于起始胰岛素治疗的 2 型糖尿病患者，双相门冬胰岛素 30 （BIAsp 30）在糖化血红蛋白降低方面比甘精胰岛素（IGlarg）更有效。本研究旨在评估 BIAsp 30 在中国的应用相对于 IGlarg 的成本效益。

方法

采用经过验证和同行评审的 CORE 糖尿病模型。肾病、视网膜病变和中风子模型经过修改，纳入了现有的中国临床数据。糖尿病并发症的成本来自于北京和成都的医院调查。模拟队列和胰岛素治疗效果基于 OnceMix 研究，比较每日一次 BIAsp 30 与 IGlarg，基于 INITIATE 研究，比较每日两次 BIAsp 30 与 IGlarg。计算预期寿命和直接医疗成本。在 30 年的时间范围内进行预测，成本和生命年以每年 3%贴现。进行了广泛的敏感性分析，包括对中国人种心血管风险的调整。

结果

基于 OnceMix 研究，每日一次 BIAsp 30 增加了 0.04 年的预期寿命（12.37 年与 12.33 年），降低了每位患者的直接医疗费用 59710 元人民币（229911 元人民币与 289621 元人民币），而与 IGlarg 相比。基于 INITIATE 研究，每日两次 BIAsp 30 增加了 0.08 年的预期寿命（12.99 年与 12.91 年），降低了每位患者的直接医疗费用 107349 元人民币（303142 元人民币与 410491 元人民币），而与 IGlarg 相比。预期寿命的改善是由于大多数糖尿病相关并发症的发生率降低所致。成本节约归因于在中国 BIAsp 30 的终身胰岛素成本低于 IGlarg。中国人种心血管风险的降低降低了 BIAsp 30 的预期临床改善，但增加了与治疗相关的终身成本节约。