Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland.
Eli Lilly and Company, Windlesham, UK.
Appl Health Econ Health Policy. 2018 Jun;16(3):357-366. doi: 10.1007/s40258-018-0379-5.
The aim of the present study was to evaluate the cost effectiveness of rapid-acting analog insulin relative to regular human insulin in adults with type 1 diabetes mellitus in Germany.
The PRIME Diabetes Model, a patient-level, discrete event simulation model, was used to project long-term clinical and cost outcomes for patients with type 1 diabetes from the perspective of a German healthcare payer. Simulated patients had a mean age of 21.5 years, duration of diabetes of 8.6 years, and baseline glycosylated hemoglobin of 7.39%. Regular human insulin and rapid-acting analog insulin regimens reduced glycosylated hemoglobin by 0.312 and 0.402%, respectively. Compared with human insulin, hypoglycemia rate ratios with rapid-acting analog insulin were 0.51 (non-severe nocturnal) and 0.80 (severe). No differences in non-severe diurnal hypoglycemia were modeled. Discount rates of 3% were applied to future costs and clinical benefits accrued over the 50-year time horizon.
In the base-case analysis, rapid-acting analog insulin was associated with an improvement in quality-adjusted life expectancy of 1.01 quality-adjusted life-years per patient (12.54 vs. 11.53 quality-adjusted life-years). Rapid-acting analog insulin was also associated with an increase in direct costs of €4490, resulting in an incremental cost-effectiveness ratio of €4427 per quality-adjusted life-year gained vs. human insulin. Sensitivity analyses showed that the base case was driven predominantly by differences in hypoglycemia; abolishing these differences reduced incremental quality-adjusted life expectancy to 0.07 quality-adjusted life-years, yielding an incremental cost-effectiveness ratio of €74,622 per quality-adjusted life-year gained.
Rapid-acting analog insulin is associated with beneficial outcomes in patients with type 1 diabetes and is likely to be considered cost effective in the German setting vs. regular human insulin.
本研究旨在评估在德国，1 型糖尿病成人患者中，速效胰岛素类似物相对于常规人胰岛素的成本效果。
使用 PRIME Diabetes Model，一种基于患者水平的离散事件模拟模型，从德国医疗保健支付者的角度来预测 1 型糖尿病患者的长期临床和成本结果。模拟患者的平均年龄为 21.5 岁，糖尿病病程为 8.6 年，基线糖化血红蛋白为 7.39%。常规人胰岛素和速效胰岛素类似物方案分别使糖化血红蛋白降低 0.312%和 0.402%。与人胰岛素相比，速效胰岛素类似物的低血糖发生率比值为 0.51（非严重夜间）和 0.80（严重）。未建模非严重日间低血糖。未来成本和 50 年时间内获得的临床效益采用 3%的贴现率进行贴现。
在基础分析中，速效胰岛素类似物可使每位患者的质量调整预期寿命增加 1.01 个质量调整生命年（12.54 比 11.53 个质量调整生命年）。速效胰岛素类似物还导致直接成本增加 4490 欧元，与常规人胰岛素相比，每获得一个质量调整生命年的增量成本效益比为 4427 欧元。敏感性分析表明，基础情况主要由低血糖差异驱动；消除这些差异将增量质量调整预期寿命降低至 0.07 个质量调整生命年，使每获得一个质量调整生命年的增量成本效益比达到 74622 欧元。
在 1 型糖尿病患者中，速效胰岛素类似物具有有益的结果，并且与常规人胰岛素相比，在德国环境下可能被认为具有成本效益。
