Li Qian, Chitnis Abhishek, Hammer Mette, Langer Jakob
Evidera, Lexington, MA, USA,
Diabetes Ther. 2014 Dec;5(2):579-90. doi: 10.1007/s13300-014-0084-9. Epub 2014 Sep 26.
The objective of this study was to compare the clinical effectiveness of liraglutide with sitagliptin and assess the associated economic outcomes in patients with type 2 diabetes mellitus (T2DM) treated in real-world practice in the United States (US).
This retrospective cohort study used a large US claims database to identify patients with T2DM who initiated liraglutide or sitagliptin between January 2010 and December 2012. Adults (≥18 years old) with persistent use of therapy for ≥3 months were included. Changes in glycated hemoglobin A1c (A1C) and the proportion of patients achieving A1C targets (≤6.5% and <7%) were examined at 6-month follow-up. Diabetes-related total, medical, and pharmacy costs over the follow-up period were assessed. Multivariable regression models were used to estimate the outcomes associated with liraglutide relative to sitagliptin, adjusting for differences in patient demographics and clinical characteristics.
The study included 1,465 patients with T2DM who initiated liraglutide (N = 376) or sitagliptin (N = 1,089) (mean age [standard deviation (SD)]: 54 [8.9] vs. 58 [10.8] years; 43.9% vs. 61.8% males; both P < 0.01). After controlling for confounding factors, liraglutide patients experienced 0.31% points greater reduction in A1C (0.95% vs. 0.63% points; P < 0.01) at 6-month follow-up than sitagliptin patients and were more likely to reach A1C targets of ≤6.5% (odds ratio [OR]: 2.00; P < 0.01) and <7% (OR: 1.55; P < 0.01). Liraglutide patients had $994 lower mean diabetes-related medical costs ($1,241 vs. $2,235; P < 0.01), but $544 higher diabetes-related pharmacy costs ($2,100 vs. $1,556; P < 0.01) during the follow-up. No difference was found in the total mean diabetes-related costs between the two cohorts.
Liraglutide showed greater improvement in glycemic outcomes than sitagliptin among adult patients with T2DM in real-world clinical practice. Although diabetes-related pharmacy costs for patients using liraglutide were higher compared with sitagliptin, these were offset by significantly lower diabetes-related medical costs, resulting in similar total diabetes-related costs between the two treatment groups.
本研究的目的是比较利拉鲁肽与西格列汀的临床疗效，并评估在美国现实临床实践中接受治疗的2型糖尿病（T2DM）患者的相关经济结局。
这项回顾性队列研究使用了一个大型美国索赔数据库，以识别在2010年1月至2012年12月期间开始使用利拉鲁肽或西格列汀的T2DM患者。纳入持续使用治疗≥3个月的成年人（≥18岁）。在6个月的随访中检查糖化血红蛋白A1c（A1C）的变化以及达到A1C目标（≤6.5%和<7%）的患者比例。评估随访期间与糖尿病相关的总费用、医疗费用和药房费用。使用多变量回归模型来估计与利拉鲁肽相对于西格列汀相关的结局，并对患者人口统计学和临床特征的差异进行调整。
该研究纳入了1465例开始使用利拉鲁肽（N = 376）或西格列汀（N = 1089）的T2DM患者（平均年龄[标准差（SD）]：54 [8.9]岁 vs. 58 [10.8]岁；男性比例43.9% vs. 61.8%；两者P < 0.01）。在控制混杂因素后，利拉鲁肽组患者在6个月随访时A1C的降低幅度比西格列汀组患者大0.31个百分点（0.95% vs. 0.63个百分点；P < 0.01），并且更有可能达到≤6.5%（优势比[OR]：2.00；P < 0.01）和<7%（OR：1.55；P < 0.01）的A1C目标。在随访期间，利拉鲁肽组患者的糖尿病相关平均医疗费用低994美元（1241美元 vs. 2235美元；P < 0.01），但糖尿病相关药房费用高544美元（2100美元 vs. 1556美元；P < 0.01）。两组之间糖尿病相关总平均费用没有差异。
在现实临床实践中，利拉鲁肽在成年T2DM患者中显示出比西格列汀更大的血糖改善效果。虽然使用利拉鲁肽的患者的糖尿病相关药房费用比西格列汀高，但这些被显著更低的糖尿病相关医疗费用所抵消，导致两个治疗组之间的糖尿病相关总费用相似。
