Chung-Ang University College of Pharmacy, 221 Heukseok-dong, Dongjak-gu, Seoul, South Korea.
Expert Rev Pharmacoecon Outcomes Res. 2011 Dec;11(6):641-55. doi: 10.1586/erp.11.73. Epub 2011 Oct 3.
The prevalence of diabetes and cost of associated treatment are steadily increasing, as is the resulting burden on healthcare systems worldwide. Current treatment recommendations for Type 1 and Type 2 diabetes advise a prominent role for basal insulin. We examined the published health-economic literature pertaining to the basal insulin analog insulin detemir (IDet) to determine whether IDet is a cost-saving and/or cost-effective treatment for suboptimally controlled Type 1 or Type 2 diabetes. A total of 15 modeling studies were assessed, most of which found IDet to be cost effective compared with neutral protamine Hagedorn and as cost effective as insulin glargine. Those that did not find IDet to be cost effective set the disutility of hypoglycemic events to almost zero or assumed a higher dose of IDet with no difference in treatment effect, ignoring the clinical benefits and cost savings associated with IDet in studies demonstrating comparable or superior glycemic control with less hypoglycemia versus other basal insulins. The evidence suggests that IDet is cost effective versus neutral protamine Hagedorn and at least as cost effective as insulin glargine in the treatment of patients with suboptimally controlled Type 1 and Type 2 diabetes.
糖尿病的患病率和相关治疗费用在稳步上升，全球医疗系统的负担也随之增加。1 型和 2 型糖尿病的现行治疗建议强调基础胰岛素的重要作用。我们查阅了已发表的有关基础胰岛素类似物地特胰岛素（IDet）的卫生经济学文献，以确定 IDet 是否是控制不佳的 1 型或 2 型糖尿病的一种节省成本和/或具有成本效益的治疗方法。共评估了 15 项建模研究，其中大多数研究发现 IDet 与中性鱼精蛋白锌胰岛素相比具有成本效益，并且与甘精胰岛素具有成本效益相当。那些认为 IDet 不具有成本效益的研究将低血糖事件的不便几乎设定为零，或者假设 IDet 的剂量更高，而治疗效果没有差异，忽略了与其他基础胰岛素相比，IDet 在具有可比或更好的血糖控制且低血糖发生率更低的研究中所具有的临床益处和成本节约。有证据表明，IDet 在治疗控制不佳的 1 型和 2 型糖尿病患者方面，与中性鱼精蛋白锌胰岛素相比具有成本效益，而且至少与甘精胰岛素具有成本效益相当。
