Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
J Diabetes Investig. 2018 Jan;9(1):152-161. doi: 10.1111/jdi.12653. Epub 2017 Apr 25.
AIMS/INTRODUCTION: Diabetic kidney disease (DKD) is the second leading cause (16.4%) of end-stage renal disease in China. The current study assessed the cost-effectiveness of preventing DKD in patients with newly diagnosed type 2 diabetes from the Chinese healthcare perspective.
A lifetime Markov decision model was developed according to the disease course of DKD. Patients with newly diagnosed type 2 diabetes might receive treatment according to one of the following three strategies: (i) "do nothing" strategy (control strategy); (ii) treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (universal strategy); (iii) or screening for microalbuminuria followed by angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker treatment (screening strategy). Clinical and utility data were obtained from the published literature. Direct medical costs and resource utilization in the Chinese healthcare setting were considered. Sensitivity analyses were undertaken to test the impact of a range of variables and assumptions on the results.
Compared with the control strategy, both the screening and universal strategies were cost-saving options that showed lower costs and better health benefits. The incremental cost-effectiveness ratio of the universal strategy over the screening strategy was US $30,087 per quality-adjusted life-year, which was higher than the cost-effectiveness threshold of China. The sensitivity analyses showed robust results, except for the probability of developing macroalbuminuria from microalbuminuria.
Screening for microalbuminuria could be a cost-saving option for the prevention of DKD in the Chinese setting.
目的/引言：在中国，糖尿病肾病（DKD）是导致终末期肾病的第二大病因（16.4%）。本研究从中国医疗保健的角度评估了预防新诊断 2 型糖尿病患者 DKD 的成本效益。
根据 DKD 的疾病进程，建立了一个终身马尔可夫决策模型。新诊断为 2 型糖尿病的患者可能会根据以下三种策略之一接受治疗：（i）“不作为”策略（对照策略）；（ii）血管紧张素转换酶抑制剂和血管紧张素 II 受体阻滞剂治疗（通用策略）；（iii）或筛查微量白蛋白尿后给予血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂治疗（筛查策略）。临床和效用数据来自已发表的文献。考虑了中国医疗保健环境中的直接医疗成本和资源利用。进行了敏感性分析，以测试一系列变量和假设对结果的影响。
与对照策略相比，筛查和通用策略都是成本节约策略，具有较低的成本和更好的健康效益。通用策略相对于筛查策略的增量成本效益比为每质量调整生命年 30087 美元，高于中国的成本效益阈值。敏感性分析结果稳健，除了微量白蛋白尿发展为大量白蛋白尿的概率外。
在中国，筛查微量白蛋白尿可能是预防 DKD 的一种节省成本的选择。
