Permsuwan Unchalee, Dilokthornsakul Piyameth, Thavorn Kednapa, Saokaew Surasak, Chaiyakunapruk Nathorn
a Faculty of Pharmacy , Chiang Mai University , Chiang Mai , Thailand.
b Center of Pharmaceutical Outcome Research (CPOR), Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand.
J Med Econ. 2017 Feb;20(2):171-181. doi: 10.1080/13696998.2016.1238386. Epub 2016 Sep 29.
With a high prevalence of chronic kidney disease (CKD) in type 2 diabetes (T2DM) in Thailand, the appropriate treatment for the patients has become a major concern. This study aimed to evaluate long-term cost-effective of dipeptidyl peptidase-4 (DPP-4) inhibitor monothearpy vs sulfonylurea (SFU) monotherapy in people with T2DM and CKD.
A validated IMS CORE Diabetes Model was used to estimate the long-term costs and outcomes. The efficacy parameters were identified and synthesized using a systematic review and meta-analysis. Baseline characteristics and cost parameters were obtained from published studies and hospital databases in Thailand. Costs were expressed in 2014 US Dollars. Outcomes were presented as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to estimate parameter uncertainty.
From a societal perspective, treatment with DPP-4 inhibitors yielded more quality-adjusted life years (QALYs) (0.024) at a higher cost (>66,000 Thai baht (THB) or >1,829.27 USD) per person than SFU, resulting in the ICER of >2.7 million THB/QALY (>74,833.70 USD/QALY). The cost-effectiveness results were mainly driven by differences in HbA1c reduction, hypoglycemic events, and drug acquisition cost of DPP-4 inhibitors. At the ceiling ratio of 160,000 THB/QALY (4,434.59 USD/QALY), the probability that DPP-4 inhibitors are cost-effective compared to SFU was less than 10%.
Compared to SFU, DPP-4 inhibitor monotherapy is not a cost-effective treatment for people with T2DM and CKD in Thailand.
鉴于泰国2型糖尿病（T2DM）患者中慢性肾脏病（CKD）的高患病率，患者的适当治疗已成为主要关注点。本研究旨在评估二肽基肽酶-4（DPP-4）抑制剂单药治疗与磺脲类药物（SFU）单药治疗对T2DM合并CKD患者的长期成本效益。
使用经过验证的IMS CORE糖尿病模型来估计长期成本和结局。通过系统评价和荟萃分析确定并综合疗效参数。基线特征和成本参数来自泰国已发表的研究和医院数据库。成本以2014年美元表示。结局以增量成本效益比（ICER）呈现。进行单因素和概率敏感性分析以估计参数不确定性。
从社会角度来看，与SFU相比，DPP-4抑制剂治疗每人可获得更多的质量调整生命年（QALY）（0.024），但成本更高（>66,000泰铢（THB）或>1,829.27美元），导致ICER>270万泰铢/QALY（>74,833.70美元/QALY）。成本效益结果主要由糖化血红蛋白降低、低血糖事件和DPP-4抑制剂的药物获取成本差异驱动。在160,000泰铢/QALY（4,434.59美元/QALY）的阈值比率下，DPP-4抑制剂比SFU更具成本效益的概率小于10%。
在泰国，与SFU相比，DPP-4抑制剂单药治疗对T2DM合并CKD患者而言并非具有成本效益的治疗方法。
