德谷胰岛素利拉鲁肽（IDegLira）固定复方制剂治疗瑞典未控制的2型糖尿病的成本效益
Cost Effectiveness of Insulin Degludec Plus Liraglutide (IDegLira) in a Fixed Combination for Uncontrolled Type 2 Diabetes Mellitus in Sweden.
作者信息
Ericsson Åsa, Lundqvist Adam
机构信息
Novo Nordisk Scandinavia AB, Box 505, 202 15, Malmö, Sweden.
IHE, The Swedish Institute for Health Economics, Lund, Sweden.
出版信息
Appl Health Econ Health Policy. 2017 Apr;15(2):237-248. doi: 10.1007/s40258-016-0301-y.
BACKGROUND
Patients with uncontrolled type 2 diabetes mellitus (T2DM) are a priority group for intensified therapy without weight gain and with low risk of hypoglycaemia.
OBJECTIVE
This study evaluates the cost effectiveness of insulin degludec plus liraglutide (IDegLira, Xultophy) compared with six potential intensification treatment options for patients with T2DM that is uncontrolled with basal insulin.
METHODS
The Swedish Institute for Health Economics (IHE) Cohort Model of Type 2 Diabetes was used with Swedish input data, a 40-year time frame and a societal perspective. The comparators for treatment intensification included insulin glargine, neutral protamine Hagedorn (NPH) insulin, insulin aspart plus either glargine or NPH, and liraglutide plus either glargine or NPH. Clinical data for all comparators (except NPH insulin) were based on an indirect treatment comparison of several studies. Prices were obtained from the 2014 Swedish Dental and Pharmaceutical Benefits Agency (Tandvårds- och läkemedelsförmånsverket [TLV]) database, and utility values were obtained from published studies. Sensitivity analyses were undertaken.
RESULTS
Overall incremental cost-effectiveness ratios (ICER) were Swedish krona (SEK) 70,000 or lower per quality-adjusted life-year (QALY). IDegLira compared with intensified basal insulin showed an ICER of SEK 28,000 per QALY versus insulin glargine, SEK70,000 per QALY versus NPH insulin and SEK 60,000 per QALY versus NPH insulin plus liraglutide. IDegLira was dominant over insulin glargine plus liraglutide and insulin aspart plus insulin glargine or NPH insulin. Results were driven by the difference in glycated haemoglobin (HbA) reduction between treatments, as confirmed by sensitivity analyses.
CONCLUSIONS
IDegLira is estimated to be a cost-effective treatment in Sweden compared with commonly used intensification treatments for patients with T2DM uncontrolled with basal insulin.
背景
2型糖尿病（T2DM）控制不佳的患者是强化治疗的重点人群，强化治疗需避免体重增加且低血糖风险低。
目的
本研究评估了德谷胰岛素利拉鲁肽（IDegLira，Xultophy）与六种潜在强化治疗方案相比的成本效益，这六种方案用于基础胰岛素治疗控制不佳的T2DM患者。
方法
采用瑞典健康经济研究所（IHE）的2型糖尿病队列模型，使用瑞典输入数据、40年时间框架和社会视角。强化治疗的对照方案包括甘精胰岛素、中性鱼精蛋白锌（NPH）胰岛素、门冬胰岛素加甘精胰岛素或NPH胰岛素，以及利拉鲁肽加甘精胰岛素或NPH胰岛素。所有对照方案（NPH胰岛素除外）的临床数据基于多项研究的间接治疗比较。价格来自2014年瑞典牙科和药品福利局（Tandvårds-och läkemedelsförmånsverket [TLV]）数据库，效用值来自已发表的研究。进行了敏感性分析。
结果
总体增量成本效益比（ICER）为每质量调整生命年（QALY）70,000瑞典克朗或更低。与强化基础胰岛素相比，IDegLira每QALY的ICER为28,000瑞典克朗（与甘精胰岛素相比）、70,000瑞典克朗（与NPH胰岛素相比）和60,000瑞典克朗（与NPH胰岛素加利拉鲁肽相比）。IDegLira优于甘精胰岛素加利拉鲁肽以及门冬胰岛素加甘精胰岛素或NPH胰岛素。敏感性分析证实，结果受治疗间糖化血红蛋白（HbA）降低差异的驱动。
结论
与常用的强化治疗方案相比，在瑞典，对于基础胰岛素治疗控制不佳的T2DM患者，IDegLira估计是一种具有成本效益的治疗方法。
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