Health Economics and Outcomes Research, IMS Health, Theaterstrasse 4, Basel, Switzerland.
J Med Econ. 2011;14(3):357-66. doi: 10.3111/13696998.2011.579213. Epub 2011 May 12.
To compare the cost-utility of exenatide once weekly (EQW) and insulin glargine in patients with type 2 diabetes in the United Kingdom (UK).
The IMS CORE Diabetes Model was used to project clinical and economic outcomes for patients with type 2 diabetes treated with EQW or insulin glargine. Treatment effects and patient baseline characteristics (mean age: 58 years, mean glycohaemoglobin: 8.3%) were taken from the DURATION-3 study. Unit costs and health state utility values were derived from published sources. As the price of EQW is not yet known, the prices of two currently available glucagon-like peptide-1 products were used as benchmarks. To reflect diabetes progression, patients started on EQW switched to insulin glargine after 5 years. The analysis was conducted from the perspective of the UK National Health Service over a time horizon of 50 years with costs and outcomes discounted at 3.5%. Sensitivity analyses explored the impact of changes in input data and assumptions and investigated the cost utility of EQW in specific body mass index (BMI) subgroups.
Incremental cost-effectiveness ratio (ICER) for EQW compared with insulin glargine.
At a price equivalent to liraglutide 1.2 mg, EQW was more effective and more costly than insulin glargine, with a base case ICER of £10,597 per quality-adjusted life-year (QALY) gained. EQW was associated with an increased time to development of any diabetes-related complication of 0.21 years, compared with insulin glargine. Three BMI subgroups investigated (<30, 30-35 and >35 kg/m(2)) reported ICERs for EQW compared with insulin glargine ranging from £9425 to £12,956 per QALY gained.
At the prices investigated, the cost per QALY gained for EQW when compared with insulin glargine in type 2 diabetes in the UK setting, was within the range normally considered cost effective by NICE. Cost effectiveness in practice will depend on the final price of EQW and the extent to which benefits observed in short-term randomised trials are replicated in long-term use.
比较每周一次艾塞那肽（EQW）和甘精胰岛素在英国（UK）2 型糖尿病患者中的成本-效用。
采用 IMS CORE 糖尿病模型预测接受 EQW 或甘精胰岛素治疗的 2 型糖尿病患者的临床和经济结局。治疗效果和患者基线特征（平均年龄：58 岁，平均糖化血红蛋白：8.3%）取自 DURATION-3 研究。单位成本和健康状态效用值源自已发表的资源。由于 EQW 的价格尚不清楚，因此使用了两种目前可用的胰高血糖素样肽-1 产品的价格作为基准。为了反映糖尿病的进展，接受 EQW 治疗的患者在 5 年后转为甘精胰岛素治疗。该分析从英国国家卫生服务体系的角度出发，时间跨度为 50 年，成本和结果以 3.5%的贴现率贴现。敏感性分析探讨了输入数据和假设变化的影响，并研究了 EQW 在特定体重指数（BMI）亚组中的成本效用。
EQW 与甘精胰岛素相比的增量成本-效果比（ICER）。
以利拉鲁肽 1.2mg 的价格计算，EQW 比甘精胰岛素更有效且更昂贵，基础病例的每获得 1 个质量调整生命年（QALY）的增量成本-效果比（ICER）为 10597 英镑。与甘精胰岛素相比，EQW 使任何糖尿病相关并发症的发生时间延迟了 0.21 年。三个研究的 BMI 亚组（<30、30-35 和>35kg/m2）报告的 EQW 与甘精胰岛素相比的 ICER 分别为每获得 1 个 QALY 增加 9425-12956 英镑。
在调查的价格范围内，与英国 2 型糖尿病患者使用甘精胰岛素相比，EQW 的每获得 1 个 QALY 的成本在 NICE 通常认为具有成本效益的范围内。在实践中的成本效益将取决于 EQW 的最终价格以及短期随机试验中观察到的益处在长期使用中的复制程度。
