IMS Health, Health Economics and Outcomes Research, London, UK.
J Med Econ. 2013 Jul;16(7):926-38. doi: 10.3111/13696998.2013.803110. Epub 2013 May 31.
The objective of this analysis was to estimate the cost-effectiveness of exenatide once weekly (EQW) for the treatment of type two diabetes mellitus (T2DM) in Spain. EQW was compared against exenatide twice daily (EBID) and insulin glargine (IG).
The IMS CORE Diabetes Model was used to project clinical and economic outcomes for patients with T2DM treated with EQW, EBID, and IG. Treatment effects and patient baseline characteristics were taken from the DURATION 3 and pooled DURATION 1 and 5 studies, in the comparison against IG and EBID, respectively. Unit costs and health state utility values were derived from published sources. To reflect diabetes progression, patients started on EQW or EBID, switching to insulin glargine after 3 years. The analysis was conducted from the perspective of the Spanish National Health Service over a time horizon of 35 years with costs and outcomes discounted at 3%. The base case included patients with a BMI > 30 kg/m(2), which is in line with current prescription restrictions in Spain. Uncertainty was addressed through extensive one-way sensitivity analyses around key model parameters and a comprehensive probabilistic sensitivity analysis.
When compared with EBID, EQW was the dominant strategy, i.e., less costly and more effective. When compared to IG, the incremental cost-effectiveness ratio was estimated at €12,084 per QALY gained. Sensitivity analysis indicated that the model projections were robust to the various scenarios tested.
Primary limitations of the analysis are common to other T2DM analyses and include the extrapolation of short-term clinical data to the 35 year time horizon and uncertainty around optimum treatment durations.
The analyses indicate that EQW is a cost-effective option for the treatment of T2DM patients in Spain for patients with a BMI > 30 kg/m(2) considering a willingness-to-pay threshold of €30,000 per QALY gained.
本分析旨在评估每周一次艾塞那肽（EQW）治疗 2 型糖尿病（T2DM）的成本效益，其对比药物为艾塞那肽每日两次（EBID）和甘精胰岛素（IG）。
IMS CORE 糖尿病模型用于预测接受 EQW、EBID 和 IG 治疗的 T2DM 患者的临床和经济结局。治疗效果和患者基线特征取自 DURATION 3 研究和汇总的 DURATION 1 和 5 研究，分别用于与 IG 和 EBID 的比较。单位成本和健康状态效用值来自已发表的资源。为了反映糖尿病的进展，接受 EQW 或 EBID 治疗的患者在 3 年后转换为甘精胰岛素。分析从西班牙国家卫生服务的角度进行，时间范围为 35 年，成本和结果贴现率为 3%。基础病例纳入 BMI>30kg/m2的患者，这与西班牙目前的处方限制一致。通过对关键模型参数进行广泛的单因素敏感性分析和全面的概率敏感性分析来解决不确定性。
与 EBID 相比，EQW 是更优策略，即成本更低且效果更佳。与 IG 相比，增量成本效益比估计为每获得 1 个质量调整生命年（QALY）增加 12084 欧元。敏感性分析表明，模型预测对测试的各种情景具有稳健性。
该分析的主要局限性与其他 T2DM 分析相同，包括将短期临床数据外推至 35 年时间范围以及最佳治疗持续时间的不确定性。
分析表明，对于 BMI>30kg/m2的 T2DM 患者，EQW 是一种具有成本效益的选择，考虑到每获得 1 个 QALY 的意愿支付阈值为 30000 欧元。
