Ossian Health Economics and Communications GmbH, Basel, Switzerland.
Clin Ther. 2011 Nov;33(11):1698-712. doi: 10.1016/j.clinthera.2011.09.022. Epub 2011 Oct 21.
The global clinical and economic burden of type 2 diabetes is substantial. Recently, clinical trials with glucagon-like peptide-1 (GLP-1) receptor agonists (liraglutide and exenatide) have shown a multifactorial clinical profile with the potential to address many of the clinical needs of patients and reduce the burden of disease.
The goal of this study was to evaluate the long-term cost-effectiveness of once-daily liraglutide versus exenatide BID in patients with type 2 diabetes who failed to improve with metformin and/or sulfonylurea, based on the results of a previous clinical trial in 6 European countries (Switzerland, Denmark, Norway, Finland, the Netherlands, and Austria).
A validated computer simulation model of diabetes was used to predict life expectancy, quality-adjusted life years (QALYs), and incidence of diabetes-related complications in patients receiving liraglutide (1.8 mg once daily) or exenatide (10 μg BID). Baseline cohort characteristics and treatment effects were derived from the Liraglutide Effect and Action in Diabetes 6 trial. Country-specific complication costs were taken from published sources. Simulations were run over 40 years from third-party payer perspectives. Future costs and clinical benefits were discounted at country-specific discount rates. Sensitivity analyses were performed.
Liraglutide was associated with improvements of 0.12 to 0.17 QALY and a reduced incidence of most diabetes-related complications versus exenatide in all settings. Evaluation of total direct medical costs (treatment plus complication costs) suggest that liraglutide was likely to cost between Euro (€) 1023 and €1866 more than exenatide over patients' lifetimes, leading to incremental cost-effectiveness ratios per QALY gained versus exenatide of: Switzerland, CHF (Swiss francs) 10,950 (€6902); Denmark, Danish krone [kr] 88,160 (€11,805); Norway, Norwegian krone [kr], 111,916 (€13,546); Finland, €8459; the Netherlands, €8119; and Austria, €8516.
Long-term projections indicated that liraglutide was associated with benefits in life expectancy, QALYs, and reduced complication rates versus exenatide. Liraglutide was cost-effective from a health care payer perspective in Switzerland, Denmark, Norway, Finland, the Netherlands, and Austria.
2 型糖尿病在全球范围内具有显著的临床和经济负担。最近，使用胰高血糖素样肽-1（GLP-1）受体激动剂（利拉鲁肽和艾塞那肽）的临床试验显示出多因素的临床特征，有可能满足患者的许多临床需求并减轻疾病负担。
本研究旨在评估每日一次利拉鲁肽与每日两次艾塞那肽在二甲双胍和/或磺酰脲类药物治疗失败的 2 型糖尿病患者中的长期成本效益，该研究基于先前在 6 个欧洲国家（瑞士、丹麦、挪威、芬兰、荷兰和奥地利）进行的临床试验结果。
使用经过验证的糖尿病计算机模拟模型来预测接受利拉鲁肽（1.8mg 每日一次）或艾塞那肽（10μg 每日两次）治疗的患者的预期寿命、质量调整生命年（QALYs）和糖尿病相关并发症的发生率。基线队列特征和治疗效果来自 Liraglutide Effect and Action in Diabetes 6 试验。各国的并发症成本来自已发表的资料。从第三方支付者的角度来看，模拟持续 40 年。未来的成本和临床效益按国家特定的贴现率贴现。进行了敏感性分析。
在所有情况下，与艾塞那肽相比，利拉鲁肽可使 QALY 提高 0.12 至 0.17，并且大多数糖尿病相关并发症的发生率降低。评估总直接医疗成本（治疗加并发症成本）表明，利拉鲁肽的终生费用可能比艾塞那肽高出 1023 至 1866 欧元，导致相对于艾塞那肽获得的每 QALY 的增量成本效益比为：瑞士，瑞士法郎（CHF）10950 （6902 欧元）；丹麦，丹麦克朗[kr]88160（11805 欧元）；挪威，挪威克朗[kr]111916（13546 欧元）；芬兰，8459 欧元；荷兰，8119 欧元；奥地利，8516 欧元。
长期预测表明，与艾塞那肽相比，利拉鲁肽可延长预期寿命、提高 QALYs 并降低并发症发生率。从医疗保健支付者的角度来看，利拉鲁肽在瑞士、丹麦、挪威、芬兰、荷兰和奥地利具有成本效益。
