Nerat Tomaž, Locatelli Igor, Kos Mitja
Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.
Patient Prefer Adherence. 2016 Oct 3;10:2039-2049. doi: 10.2147/PPA.S114602. eCollection 2016.
Type 2 diabetes is a major burden for the payer, however, with proper medication adherence, diet and exercise regime, complication occurrence rates, and consequently costs can be altered.
The aim of this study was to conduct a cost-effectiveness analysis on real patient data and evaluate which medication adherence or lifestyle intervention is less cost demanding for the payer.
Medline was searched systematically for published type 2 diabetes interventions regarding medication adherence and lifestyle in order to determine their efficacies, that were then used in the cost-effectiveness analysis. For cost-effectiveness analysis-required disease progression simulation, United Kingdom Prospective Diabetes Study Outcomes model 2.0 and Slovenian type 2 diabetes patient cohort were used. The intervention duration was set to 1, 2, 5, and 10 years. Complications and drug costs in euro (EUR) were based on previously published type 2 diabetes costs from the Health Care payer perspective in Slovenia.
Literature search proved the following interventions to be effective in type 2 diabetes patients: medication adherence, the Mediterranean diet, aerobic, resistance, and combined exercise. The long-term simulation resulted in no payer net savings. The model predicted following quality-adjusted life-years (QALY) gained and incremental costs for QALY gained (EUR/QALYg) after 10 years of intervention: high-efficacy medication adherence (0.245 QALY; 9,984 EUR/QALYg), combined exercise (0.119 QALY; 46,411 EUR/QALYg), low-efficacy medication adherence (0.075 QALY; 30,967 EUR/QALYg), aerobic exercise (0.069 QALY; 80,798 EUR/QALYg), the Mediterranean diet (0.057 QALY; 27,246 EUR/QALYg), and resistance exercise (0.050 QALY; 111,847 EUR/QALYg).
The results suggest that medication adherence intervention is, regarding cost-effectiveness, superior to diet and exercise interventions from the payer perspective. However, the latter could also be utilized by patients without additional costs, but medication adherence intervention requires trained personnel because of its complex structure. Interventions should be performed for >2 years to produce noticeable health/cost results.
2型糖尿病给医保支付方带来了沉重负担，然而，通过适当的药物依从性、饮食和运动方案，可以改变并发症发生率，进而降低成本。
本研究旨在对真实患者数据进行成本效益分析，评估哪种药物依从性或生活方式干预对医保支付方来说成本更低。
系统检索Medline数据库中已发表的关于2型糖尿病药物依从性和生活方式的干预措施，以确定其疗效，然后将其用于成本效益分析。对于成本效益分析所需的疾病进展模拟，使用了英国前瞻性糖尿病研究结果模型2.0和斯洛文尼亚2型糖尿病患者队列。干预持续时间设定为1年、2年、5年和10年。并发症和药物成本以欧元（EUR）为单位，基于此前从斯洛文尼亚医保支付方角度发表的2型糖尿病成本。
文献检索证明以下干预措施对2型糖尿病患者有效：药物依从性、地中海饮食、有氧运动、抗阻运动和联合运动。长期模拟结果显示医保支付方没有净节省。该模型预测了干预10年后获得的质量调整生命年（QALY）以及获得QALY的增量成本（EUR/QALYg）：高效能药物依从性（0.245 QALY；9,984 EUR/QALYg）、联合运动（0.119 QALY；46,411 EUR/QALYg）、低效能药物依从性（0.075 QALY；30,967 EUR/QALYg）、有氧运动（0.069 QALY；80,798 EUR/QALYg）、地中海饮食（0.057 QALY；27,246 EUR/QALYg）和抗阻运动（0.050 QALY；111,847 EUR/QALYg）。
结果表明，从医保支付方的角度来看，在成本效益方面，药物依从性干预优于饮食和运动干预。然而，患者也可以采用后者且无需额外费用，但由于药物依从性干预结构复杂，需要专业人员指导。干预应持续超过2年才能产生显著的健康/成本效果。
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