Neslusan Cheryl, Teschemaker Anna, Johansen Pierre, Willis Michael, Valencia-Mendoza Atanacio, Puig Andrea
Janssen Global Services, LLC, Raritan, NJ, USA.
Janssen Global Services, LLC, Raritan, NJ, USA.
Value Health Reg Issues. 2015 Dec;8:8-19. doi: 10.1016/j.vhri.2015.01.002. Epub 2015 Jun 3.
To assess the cost-effectiveness of canagliflozin versus sitagliptin for the treatment of type 2 diabetes mellitus (T2DM) as an add-on to metformin in Mexico.
A validated model (Economic and Health Outcomes [ECHO]-T2DM) was used to estimate the cost-effectiveness of canagliflozin 300 or 100 mg versus sitagliptin 100 mg in patients with T2DM inadequately controlled on metformin monotherapy. Data from a head-to-head, phase III clinical trial, including patients' baseline demographic characteristics, biomarker values, and treatment effects, were used to simulate outcomes and resource use over 20 years from the perspective of the Mexican health care system. Costs of complications and adverse events were tailored to the Mexican setting and discounted at 5%. Cost-effectiveness was assessed using willingness-to-pay thresholds equivalent to 1 times the gross domestic product per capita (locally perceived to be "very cost-effective") and 3 times the gross domestic product per capita (locally perceived to be "cost-effective") on the basis of recommendations of the Mexican government and the World Health Organization.
Owing primarily to better glycated hemoglobin (HbA), body weight, and systolic blood pressure values, canagliflozin 300 and 100 mg were associated with an incremental benefit of 0.16 and 0.06 quality-adjusted life-years (QALYs) versus sitagliptin 100 mg, respectively, over 20 years. The mean differences in cost for canagliflozin 300 and 100 mg versus sitagliptin 100 mg were Mexican pesos (MXP) 1797 (US $134) and MXP 7262 (US $540), respectively, resulting in a cost per QALY gained of MXP 11,210 (US $834) and MXP 128,883 (US $9590), respectively. Both of these cost-effectiveness ratios are below the very cost-effective willingness-to-pay threshold in Mexico. The general finding that canagliflozin is cost-effective versus sitagliptin in Mexico was supported by sensitivity analyses.
In Mexico, both doses of canagliflozin are likely to be cost-effective versus sitagliptin in patients with T2DM who have inadequate glucose control on metformin, primarily because of better biomarker control and higher QALYs.
评估在墨西哥，卡格列净与西格列汀作为二甲双胍的附加治疗用于2型糖尿病（T2DM）治疗的成本效益。
采用一个经过验证的模型（经济与健康结果[ECHO]-T2DM）来估计在二甲双胍单药治疗血糖控制不佳的T2DM患者中，300毫克或100毫克卡格列净与100毫克西格列汀的成本效益。来自一项头对头III期临床试验的数据，包括患者的基线人口统计学特征、生物标志物值和治疗效果，从墨西哥医疗保健系统的角度用于模拟20年的结局和资源使用情况。并发症和不良事件的成本根据墨西哥的情况进行调整，并按每年5%的贴现率进行贴现。根据墨西哥政府和世界卫生组织的建议，使用相当于人均国内生产总值1倍（当地认为“非常具有成本效益”）和3倍（当地认为“具有成本效益”）的支付意愿阈值来评估成本效益。
主要由于糖化血红蛋白（HbA）、体重和收缩压值更佳，在20年期间，300毫克和100毫克卡格列净相对于100毫克西格列汀分别带来了0.16和0.06个质量调整生命年（QALY）的增量效益。300毫克和100毫克卡格列净相对于100毫克西格列汀的平均成本差异分别为1797墨西哥比索（134美元）和7262墨西哥比索（540美元），导致每获得一个QALY的成本分别为11210墨西哥比索（834美元）和128883墨西哥比索（9590美元）。这两个成本效益比均低于墨西哥非常具有成本效益的支付意愿阈值。敏感性分析支持了卡格列净在墨西哥相对于西格列汀具有成本效益这一总体发现。
在墨西哥，对于二甲双胍治疗血糖控制不佳的T2DM患者，两种剂量的卡格列净相对于西格列汀可能都具有成本效益，主要是因为其对生物标志物的控制更好且QALY更高。
