Ektare Varun U, Lopez Janice M S, Martin Silas C, Patel Dipen A, Rupnow Marcia F T, Botteman Marc F
4350 E W Highway, Ste 430, Bethesda, MD 20814. E-mail: mbotteman@pharmerit .com.
Am J Manag Care. 2014 Oct;20(10 Suppl):S204-15.
To compare 1-year clinical outcomes and cost efficiency of treating adults with type 2 diabetes mellitus (T2DM) with canagliflozin (300 mg/day) or sitagliptin (100 mg/day), both added on a background of metformin and sulfonylurea.
An economic model integrated data from an active-controlled, randomized trial, claims database analyses, and published literature.
The model adopted a US managed care payer perspective and included the clinical and economic impact of achieving specific clinical quality goals. The model was run separately for 2 single clinical quality metrics, glycated hemoglobin (A1C) < 7% (used as base case) or < 8%, and 4 composite metrics (A1C < 7% or < 8% combined with body mass index < 30 kg/m2 and blood pressure < 140/90 mm Hg or low-density lipoprotein cholesterol < 100 mg/dL). Cost savings of achieving versus not achieving metrics were derived from a claims database analysis. Drug and adverse event costs were included.
In the base case, compared with sitagliptin 100 mg, treatment with canagliflozin 300 mg resulted in $215 in annual cost savings and 12.3 absolute percentage points more patients achieving goal. Similar findings were found across all other quality metrics (difference in proportion achieving goal ranging from 6.7% to 19.0% and annual savings ranging from $1 to $669). Canagliflozin remained cost saving versus sitagliptin in sensitivity analyses.
Canagliflozin 300 mg may represent a cost-efficient T2DM treatment option versus sitagliptin 100 mg for patients on metformin plus sulfonylurea due to lower overall costs and better achievement of A1C and quality composite goals.
比较在二甲双胍和磺脲类药物基础上加用卡格列净（300毫克/天）或西格列汀（100毫克/天）治疗2型糖尿病（T2DM）成人患者的1年临床结局和成本效益。
一个经济模型整合了来自一项活性对照随机试验、索赔数据库分析和已发表文献的数据。
该模型采用美国管理式医疗支付方的视角，纳入了实现特定临床质量目标的临床和经济影响。该模型分别针对2个单一临床质量指标（糖化血红蛋白[HbA1c]<7%[用作基础病例]或<8%）以及4个综合指标（HbA1c<7%或<8%与体重指数<30千克/平方米以及血压<140/90毫米汞柱或低密度脂蛋白胆固醇<100毫克/分升相结合）运行。实现与未实现指标的成本节约来自索赔数据库分析。纳入了药物和不良事件成本。
在基础病例中，与100毫克西格列汀相比，300毫克卡格列净治疗每年节省成本215美元，实现目标的患者绝对百分比多12.3个百分点。在所有其他质量指标中也发现了类似结果（实现目标的比例差异在6.7%至19.0%之间，每年节省成本在1美元至669美元之间）。在敏感性分析中，卡格列净与西格列汀相比仍具有成本节约优势。
对于接受二甲双胍加磺脲类药物治疗的患者，300毫克卡格列净与100毫克西格列汀相比，可能是一种具有成本效益的T型糖尿病治疗选择，因为其总体成本更低，且在实现HbA1c和质量综合目标方面表现更佳。
