每周一次艾塞那肽对比甘精胰岛素和利拉鲁肽治疗希腊 2 型糖尿病的成本效果分析。
Cost Effectiveness of Exenatide Once Weekly Versus Insulin Glargine and Liraglutide for the Treatment of Type 2 Diabetes Mellitus in Greece.
机构信息
Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece.
Department of Endocrinology and Metabolic Diseases, University of Thessaly School of Medicine, Larissa, Greece.
出版信息
Clin Drug Investig. 2018 Jan;38(1):67-77. doi: 10.1007/s40261-017-0586-0.
OBJECTIVE
The objective of this study was to evaluate the long-term cost effectiveness of exenatide once weekly (ExQW) versus insulin glargine (IG) or liraglutide 1.2 mg (Lira1.2mg) for the treatment of adult patients with type 2 diabetes mellitus (T2DM) not adequately controlled on oral antidiabetic drug (OAD) therapy in Greece.
METHODS
The published and validated Cardiff Diabetes Model was used to project clinical and economic outcomes over a patient's lifetime. Clinical data were retrieved from a head-to-head clinical trial (DURATION 3) and a published network meta-analysis comparing ExQW with IG or Lira1.2mg, respectively. Following a Greek third-party payer perspective, direct medical costs related to drug acquisition, consumables, developed micro- and macrovascular complications, maintenance treatment, as well as treatment-related adverse events were considered. Cost and utility data were extracted from literature and publicly available official sources and assigned to model parameters to calculate total quality-adjusted life-years (QALYs) and total costs as well as incremental cost-effectiveness ratios (ICERs). Sensitivity analyses explored the impact of changes in input data.
RESULTS
Over a patient's lifetime, ExQW was associated with 0.458 or 0.039 incremental QALYs compared with IG or Lira1.2mg, respectively, at additional costs of €2061 or €110, respectively. The ICER for ExQW was €4499/QALY compared with IG and €2827/QALY compared with Lira1.2mg. Results were robust across various one-way and scenario analyses. At the defined willingness-to-pay threshold of €36,000/QALY, probabilistic sensitivity analysis showed that ExQW had a 100 or 88.2% probability of being cost effective relative to IG or Lira1.2mg, respectively.
CONCLUSIONS
ExQW was estimated to be cost effective relative to IG or Lira1.2mg for the treatment of T2DM in adults not adequately controlled on OAD therapy in Greece.
目的
本研究旨在评估每周一次艾塞那肽（ExQW）对比胰岛素甘精（IG）或利拉鲁肽 1.2mg（Lira1.2mg）用于治疗口服降糖药（OAD）治疗控制不佳的希腊成人 2 型糖尿病（T2DM）患者的长期成本效果。
方法
使用已发表且经验证的卡迪夫糖尿病模型来预测患者一生中的临床和经济结局。临床数据取自头对头临床试验（DURATION 3）和一项已发表的网络荟萃分析，分别比较 ExQW 与 IG 或 Lira1.2mg。基于希腊第三方支付者视角，考虑了与药物获取、耗材、微血管和大血管并发症的发展、维持治疗以及治疗相关不良反应相关的直接医疗成本。成本和效用数据从文献和公开的官方来源中提取，并分配给模型参数，以计算总质量调整生命年（QALYs）和总成本以及增量成本效果比（ICER）。敏感性分析探讨了输入数据变化的影响。
结果
在患者的一生中，与 IG 或 Lira1.2mg 相比，ExQW 分别额外增加了 2061 欧元或 110 欧元的成本，分别导致 0.458 或 0.039 个增量 QALYs。ExQW 与 IG 的 ICER 为 4499 欧元/QALY，与 Lira1.2mg 的 ICER 为 2827 欧元/QALY。在各种单因素和情景分析中，结果都是稳健的。在 36000 欧元/QALY 的既定意愿支付阈值下，概率敏感性分析表明，ExQW 相对于 IG 或 Lira1.2mg 的成本效果的概率分别为 100%或 88.2%。
结论
ExQW 被认为在希腊 OAD 治疗控制不佳的成人 T2DM 患者中相对于 IG 或 Lira1.2mg 具有成本效果。
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