Hunt Barnaby, Ye Qing, Valentine William J, Ashley Donna
Ossian Health Economics and Communications, Basel, Switzerland.
Novo Nordisk A/S, Søborg, Denmark.
Diabetes Ther. 2017 Feb;8(1):129-147. doi: 10.1007/s13300-016-0219-2. Epub 2017 Jan 5.
The glucagon-like peptide-1 (GLP-1) receptor agonist class has grown in the last decade, with several agents available in the UK. However there is currently a paucity of evidence regarding the relative cost-effectiveness of liraglutide 1.2 mg versus other daily administered GLP-1 receptor agonists, due to a lack of head-to-head trial data. Therefore the present analysis was performed, using results from a network meta-analysis (NMA), to compare the cost-effectiveness of three currently available daily administered GLP-1 receptor agonists for treatment of diabetes in the UK setting.
A validated and published diabetes model was used to make long-term projections of clinical outcomes and direct costs (2015 GBP) for patients receiving liraglutide 1.2 mg once-daily, exenatide 10 μg twice daily and lixisenatide 20 μg once-daily. Treatment effects were taken from an NMA evaluating the efficacy of GLP-1 receptor agonists and were applied in a cohort based on the Liraglutide Effect and Action in Diabetes 6 (LEAD-6) trial. Costs and utilities were based on published sources.
Liraglutide 1.2 mg was associated with improved quality-adjusted life expectancy versus exenatide [9.19 versus 9.17 quality-adjusted life years (QALYs)] and lixisenatide (9.19 versus 9.12 QALYs). Improvements were driven by benefits in glycemic control, leading to a reduced incidence of diabetes-related complications. Liraglutide 1.2 mg was associated with reduced costs versus exenatide (GBP 36,394 versus GBP 36,547) and lixisenatide (GBP 36,394 versus GBP 36,496), with cost savings as a result of complications avoided entirely offsetting increased acquisition costs. Based on the projected outcomes, liraglutide was found to be dominant over both exenatide and lixisenatide.
Liraglutide 1.2 mg is likely to be considered cost-effective versus alternative daily administered GLP-1 receptor agonists for treatment of type 2 diabetes in the UK.
在过去十年中，胰高血糖素样肽-1（GLP-1）受体激动剂类药物不断增加，英国有几种此类药物可供使用。然而，由于缺乏直接对比试验数据，目前关于1.2毫克利拉鲁肽与其他每日给药的GLP-1受体激动剂的相对成本效益的证据很少。因此，本分析使用网络荟萃分析（NMA）的结果，比较了英国目前三种每日给药的GLP-1受体激动剂治疗糖尿病的成本效益。
使用经过验证并发表的糖尿病模型，对每日一次接受1.2毫克利拉鲁肽、每日两次接受10微克艾塞那肽和每日一次接受20微克利司那肽治疗的患者的临床结局和直接成本（2015年英镑）进行长期预测。治疗效果取自一项评估GLP-1受体激动剂疗效的NMA，并应用于基于利拉鲁肽在糖尿病中的作用及疗效6（LEAD-6）试验的队列中。成本和效用基于已发表的资料来源。
与艾塞那肽相比，1.2毫克利拉鲁肽可改善质量调整预期寿命[分别为9.19和9.17质量调整生命年（QALY）]，与利司那肽相比也有改善（分别为9.19和9.12 QALY）。改善是由血糖控制方面的益处推动的，导致糖尿病相关并发症的发生率降低。与艾塞那肽相比，1.2毫克利拉鲁肽的成本降低（36,394英镑对36,547英镑），与利司那肽相比也降低（36,394英镑对36,496英镑），因避免并发症而节省的成本完全抵消了增加的采购成本。根据预测结果，发现利拉鲁肽比艾塞那肽和利司那肽都更具优势。
在英国，对于2型糖尿病的治疗，1.2毫克利拉鲁肽与其他每日给药的GLP-1受体激动剂相比，可能被认为具有成本效益。
