Farahani Pendar
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Int J Endocrinol. 2018 Jul 8;2018:3718958. doi: 10.1155/2018/3718958. eCollection 2018.
Nonsevere hypoglycemia episodes (NSHEs) are associated with clinically adverse outcomes, lower health-related quality of life, increased burden of disease, and reduced work productivity.
To estimate prevalence of NSHEs and associated economic outcomes attributable to sulfonylurea (SU) versus sodium-glucose cotransporter 2 inhibitor (SGLT2i) initiation after metformin over one year for Canadian patients with type 2 diabetes (T2DM).
Risk difference for NSHEs was calculated for SU and SGLT2i from RCT data. Estimation of NSHEs attributable to SU utilization in Canada was calculated from published data. Both direct and indirect costs associated with NSHEs were obtained from previous published studies in literature.
The number of patients with T2DM and exposure to SU in Canada in 2016 was estimated to be 1,246,438. The average underreported NSHEs in clinical settings were estimated at 67.7%. Risk difference for NSHEs for SU versus SGLT2i was estimated at 26.7%. Estimation of excess NSHEs attributable to SU utilization versus SGLT2i in Canada was estimated at 130,434 events per year (sensitivity analysis: minimum 80,680 and maximum 624,465). Total indirect costs including loss-of-work productivity and out-of-pocket costs secondary to excess NSHEs due to SU utilization versus SGLT2i after metformin were estimated at CDN$8.6M (M = millions) for 2016 (sensitivity analysis: minimum CDN$5.3M and maximum CDN$81.2M).
NSHE, which is a forgotten variable in economic evaluations for healthcare reimbursement models, occurs frequently in real-world clinical settings but is infrequently reported. NSHEs can lead to a significant loss-of-work productivity and out-of-pocket costs.
非严重低血糖事件（NSHEs）与临床不良结局、健康相关生活质量降低、疾病负担增加以及工作效率下降有关。
估计加拿大2型糖尿病（T2DM）患者在二甲双胍治疗一年后起始使用磺脲类药物（SU）与钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）相比，NSHEs的患病率及相关经济结局。
从随机对照试验（RCT）数据计算SU和SGLT2i的NSHEs风险差异。根据已发表数据计算加拿大因使用SU导致的NSHEs估计值。与NSHEs相关的直接和间接成本均来自先前发表的文献研究。
估计2016年加拿大T2DM患者且使用SU的人数为1,246,438。临床环境中NSHEs平均漏报率估计为67.7%。SU与SGLT2i的NSHEs风险差异估计为26.7%。估计加拿大因使用SU而非SGLT2i导致的额外NSHEs每年为130,434例（敏感性分析：最小值80,680例，最大值624,465例）。2016年，因使用SU而非SGLT2i在二甲双胍治疗后导致的额外NSHEs所产生的包括工作效率损失和自付费用在内的总间接成本估计为860万加元（M = 百万）（敏感性分析：最小值530万加元，最大值8120万加元）。
NSHEs在医疗保健报销模型的经济评估中是一个被遗忘的变量，在现实世界临床环境中频繁发生但很少被报告。NSHEs可导致工作效率显著损失和自付费用增加。
