Gu Shuyan, Zeng Yuhang, Yu Demin, Hu Xiaoqian, Dong Hengjin
Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China.
Key Laboratory of Hormones and Development (Ministry of Health), Metabolic Diseases Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China.
PLoS One. 2016 Nov 22;11(11):e0167190. doi: 10.1371/journal.pone.0167190. eCollection 2016.
This study assessed the long-term cost-effectiveness of saxagliptin+metformin (SAXA+MET) versus acarbose+metformin (ACAR+MET) in Chinese patients with type 2 diabetes mellitus (T2DM) inadequately controlled on MET alone.
Systematic literature reviews were performed to identify studies directly comparing SAXA+MET versus ACAR+MET, and to obtain diabetes-related events costs which were modified by hospital surveys. A Cardiff Diabetes Model was used to estimate the long-term economic and health treatment consequences in patients with T2DM. Costs (2014 Chinese yuan) were calculated from the payer's perspective and estimated over a patient's lifetime.
SAXA+MET predicted lower incidences of most cardiovascular events, hypoglycemia events and fatal events, and decreased total costs compared with ACAR+MET. For an individual patient, the quality-adjusted life-years (QALYs) gained with SAXA+MET was 0.48 more than ACAR+MET at a cost saving of ¥18,736, which resulted in a cost saving of ¥38,640 per QALY gained for SAXA+MET versus ACAR+MET. Results were robust across various univariate and probabilistic sensitivity analyses.
SAXA+MET is a cost-effective treatment alternative compared with ACAR+MET for patients with T2DM in China, with a little QALYs gain and lower costs. SAXA is an effective, well-tolerated drug with a low incidence of adverse events and ease of administration; it is anticipated to be an effective second-line therapy for T2DM treatment.
本研究评估了在中国2型糖尿病（T2DM）患者中，沙格列汀+二甲双胍（SAXA+MET）与阿卡波糖+二甲双胍（ACAR+MET）相比，对仅使用二甲双胍血糖控制不佳患者的长期成本效益。
进行系统的文献综述，以确定直接比较SAXA+MET与ACAR+MET的研究，并通过医院调查获取糖尿病相关事件成本。使用卡迪夫糖尿病模型估计T2DM患者的长期经济和健康治疗后果。成本（2014年人民币）从支付者角度计算，并估计患者一生的成本。
与ACAR+MET相比，SAXA+MET预测大多数心血管事件（CVD）、低血糖事件和致命事件的发生率更低，总成本降低。对于个体患者，SAXA+MET获得的质量调整生命年（QALY）比ACAR+MET多0.48，节省成本18,736元，这使得SAXA+MET相对于ACAR+MET每获得一个QALY节省成本38,640元。在各种单变量和概率敏感性分析中，结果均稳健。
在中国T2DM患者中，与ACAR+MET相比，SAXA+MET是一种具有成本效益的治疗选择，获得的QALY略有增加且成本更低。SAXA是一种有效、耐受性良好的药物，不良事件发生率低且易于给药；预计它将成为T2DM治疗的有效二线治疗药物。
