Steen Carlsson Katarina, Persson Ulf
The Swedish Institute for Health Economics, IHE , Lund , Sweden.
J Med Econ. 2014 Sep;17(9):658-69. doi: 10.3111/13696998.2014.933110. Epub 2014 Jun 26.
To evaluate long-run cost-effectiveness in a Swedish setting for liraglutide compared with sulphonylureas (glimepiride) or sitagliptin, all as add-on to metformin for patients with type 2 diabetes insufficiently controlled with metformin in monotherapy.
The IHE Cohort Model of Type 2 Diabetes was used to evaluate clinical and economic outcomes from a societal perspective. Model input data were obtained from two clinical trials, the Swedish National Diabetes Register and the literature. Cost data reflected year 2013 price level. The robustness of results was checked with one-way-sensitivity analysis and probability sensitivity analysis.
The cost per QALY gained for liraglutide (1.2 mg) compared to SU (glimepiride 4 mg), both as add-on to metformin, ranged from SEK 226,000 to SEK 255,000 in analyzed patient cohorts. The cost per QALY for liraglutide (1.2 mg) vs sitagliptin (100 mg) as second-line treatment was lower, ranging from SEK 149,000 to SEK 161,000. Costs of preventive treatment were driving costs, but there was also a cost offset from reduced costs of complications of ∼ 20%. Notable cost differences were found for nephropathy, stroke, and heart failure. The predicted life expectancy with liraglutide increased the cost of net consumption for liraglutide.
The analysis was an ex-ante analysis using model input data from clinical trials which may not reflect effectiveness in real-world clinical practice in broader patient populations. This limitation was explored in the sensitivity analysis. The lack of specific data on loss of production due to diabetes complications implied that these costs may be under-estimated.
Treatment strategies with liraglutide 1.2 mg improved the expected quality-of-life and increased costs when compared to SU and to sitagliptin for second-line add-on treatments. The cost per QALY for liraglutide was in the range considered medium by Swedish authorities.
在瑞典的背景下，评估利拉鲁肽与磺脲类药物（格列美脲）或西格列汀相比的长期成本效益，所有这些药物均作为二甲双胍单药治疗血糖控制不佳的2型糖尿病患者的附加治疗药物。
使用2型糖尿病的IHE队列模型从社会角度评估临床和经济结果。模型输入数据来自两项临床试验、瑞典国家糖尿病登记处和文献。成本数据反映了2013年的物价水平。通过单向敏感性分析和概率敏感性分析检查结果的稳健性。
在分析的患者队列中，与作为二甲双胍附加治疗药物的磺脲类药物（4毫克格列美脲）相比，利拉鲁肽（1.2毫克）每获得一个质量调整生命年的成本在226,000瑞典克朗至255,000瑞典克朗之间。作为二线治疗药物，利拉鲁肽（1.2毫克）与西格列汀（100毫克）相比，每质量调整生命年的成本较低，在149,000瑞典克朗至161,000瑞典克朗之间。预防性治疗成本是驱动成本，但并发症成本降低约20%也带来了成本抵消。在肾病、中风和心力衰竭方面发现了显著的成本差异。利拉鲁肽预计的预期寿命增加了利拉鲁肽的净消费成本。
该分析是一项事前分析，使用了来自临床试验的模型输入数据，可能无法反映更广泛患者群体在现实临床实践中的有效性。在敏感性分析中探讨了这一局限性。由于缺乏糖尿病并发症导致的生产损失的具体数据，意味着这些成本可能被低估。
与作为二线附加治疗药物的磺脲类药物和西格列汀相比，1.2毫克利拉鲁肽的治疗策略改善了预期生活质量并增加了成本。利拉鲁肽每质量调整生命年的成本在瑞典当局认为的中等范围内。
