Pöhlmann Johannes, Russel-Szymczyk Monika, Holík Pavel, Rychna Karel, Hunt Barnaby
Ossian Health Economics and Communications, Basel, Switzerland.
Novo Nordisk Pharma Sp. z.o.o., Warsaw, Poland.
Diabetes Ther. 2019 Apr;10(2):493-508. doi: 10.1007/s13300-019-0569-7. Epub 2019 Jan 31.
Few patients with type 2 diabetes mellitus (T2DM) achieve recommended glycemic control targets in the Czech Republic. Novel therapies, such as fixed-ratio combinations of basal insulin plus glucagon-like peptide-1 receptor agonists, may contribute to better glycemic control. In the analysis presented here, the present analysis assessed the long-term cost-effectiveness of two fixed-ratio combinations, IDegLira (insulin degludec/liraglutide) and iGlarLixi (insulin glargine/lixisenatide), for the treatment of patients with T2DM inadequately controlled with basal insulin from a healthcare payer perspective in the Czech Republic.
A cost-effectiveness analysis was performed over patient lifetimes using the IQVIA CORE Diabetes Model. Treatment effects were obtained from an indirect treatment comparison as no head-to-head data for IDegLira versus iGlarLixi are currently available. IDegLira was compared with two iGlarLixi pens (100 U/mL insulin glargine + 33 μg/mL and 50 μg/mL of lixisenatide, respectively). Direct medical costs associated with pharmaceutical interventions, screening and diabetes-related complications were captured. Deterministic and probabilistic sensitivity analyses were performed.
IDegLira was associated with gains in life expectancy of 0.11 years and in quality-adjusted life expectancy of 0.14 quality-adjusted life-years (QALYs) versus iGlarLixi, due to a lower cumulative incidence and delayed onset of diabetes-related complications. IDegLira was also associated with higher projected costs due to higher acquisition costs; however, these were partially offset by cost savings from avoided complications. IDegLira was associated with incremental cost-effectiveness ratios of Czech Koruna (CZK) 695,998 and CZK 348,323 per QALY gained versus iGlarLixi pens containing 33 and 50 μg/mL of lixisenatide, respectively. These ratios were below the commonly used willingness-to-pay threshold of CZK 1,200,000 per QALY gained.
The present analysis indicated that IDegLira was associated with clinical benefits relative to iGlarLixi over patient lifetimes and was likely to be cost-effective in the treatment of patients with T2DM uncontrolled on basal insulin in the Czech Republic.
Novo Nordisk. Plain language summary is available for this article.
在捷克共和国，很少有2型糖尿病（T2DM）患者能达到推荐的血糖控制目标。新型疗法，如基础胰岛素与胰高血糖素样肽-1受体激动剂的固定比例组合，可能有助于更好地控制血糖。在本分析中，从捷克医疗保健支付方的角度评估了两种固定比例组合，即德谷胰岛素利拉鲁肽（IDegLira）和甘精胰岛素利西拉肽（iGlarLixi），用于治疗基础胰岛素控制不佳的T2DM患者的长期成本效益。
使用IQVIA核心糖尿病模型对患者的一生进行成本效益分析。由于目前尚无IDegLira与iGlarLixi的直接对比数据，治疗效果通过间接治疗比较获得。将IDegLira与两种iGlarLixi笔（分别为100 U/mL甘精胰岛素 + 33 μg/mL和50 μg/mL利西拉肽）进行比较。记录与药物干预、筛查和糖尿病相关并发症相关的直接医疗费用。进行了确定性和概率性敏感性分析。
与iGlarLixi相比，IDegLira可使预期寿命增加0.11年，质量调整预期寿命增加0.14个质量调整生命年（QALY），这是由于糖尿病相关并发症的累积发生率较低且发病延迟。由于采购成本较高，IDegLira的预计成本也较高；然而，避免并发症带来的成本节省部分抵消了这些成本。与分别含有33 μg/mL和50 μg/mL利西拉肽的iGlarLixi笔相比，IDegLira每获得一个QALY的增量成本效益比分别为695,998捷克克朗（CZK）和348,323捷克克朗。这些比率低于常用的每获得一个QALY支付意愿阈值1,200,000捷克克朗。
本分析表明，在患者的一生中，与iGlarLixi相比，IDegLira具有临床益处，并且在治疗捷克共和国基础胰岛素控制不佳的T2DM患者中可能具有成本效益。
诺和诺德公司。本文提供了通俗易懂的总结。
