芬兰2型糖尿病控制不佳患者中持续皮下胰岛素输注与多次皮下注射的成本效益分析
Cost-Effectiveness of Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections in Patients with Poorly Controlled Type 2 Diabetes in Finland.
作者信息
Roze Stephané, Smith-Palmer Jayne, Delbaere Alexis, Bjornstrom Karita, de Portu Simona, Valentine William, Honkasalo Mikko
机构信息
HEVA HEOR, 186 Avenue Thiers, 69006, Lyon, France.
Ossian Health Economics and Communications, Bäumleingasse 20, 4051, Basel, Switzerland.
出版信息
Diabetes Ther. 2019 Apr;10(2):563-574. doi: 10.1007/s13300-019-0575-9. Epub 2019 Feb 7.
INTRODUCTION
Although primarily utilized in type 1 diabetes, continuous subcutaneous insulin infusion (CSII) represents a useful treatment alternative for patients with type 2 diabetes who are unable to achieve good glycemic control despite optimization of multiple daily injections (MDI). The aim of the analysis reported here was to investigate the long-term cost-effectiveness of CSII versus MDI in type 2 diabetes patients with poor glycemic control in Finland.
METHODS
The IQVIA CORE Diabetes Model was used to make long-term projections of the clinical and economic outcomes associated with CSII use in type 2 diabetes, based on clinical input data from the OpT2mise trial, which showed that CSII was associated with a 1.1% decrease in glycated hemoglobin (HbA1c) in patients with poor glycemic control at baseline. The analysis was performed from a societal perspective and the time horizon was that of patient lifetimes. Future costs and clinical outcomes were discounted at 3% per annum.
RESULTS
Continuous subcutaneous insulin infusion was associated with a gain in quality-adjusted life expectancy of 0.32 quality-adjusted life-years (QALYs) compared with MDI (8.15 vs. 7.83 QALYs, respectively), as well as higher mean lifetime costs, resulting in an incremental cost-effectiveness ratio of Euro (EUR) 47,834 per QALY gained for CSII versus MDI. The higher treatment costs in the CSII group were partly mitigated by a 15% reduction in diabetes-related complication costs. Sensitivity analyses demonstrated that CSII was most cost-effective in patients with the highest baseline HbA1c values.
CONCLUSION
In Finland, CSII is likely to represent a cost-effective treatment alternative for patients with type 2 diabetes with poor glycemic control despite optimization of MDI. In such patients, CSII is associated with improved clinical outcomes relative to MDI, with the higher acquisition costs partly offset by a lower lifetime incidence and cost of diabetes-related complications.
FUNDING
Medtronic International Sàrl.
引言
尽管持续皮下胰岛素输注（CSII）主要用于1型糖尿病，但对于那些尽管优化了每日多次注射（MDI）仍无法实现良好血糖控制的2型糖尿病患者而言，它是一种有效的治疗选择。本文报告的分析目的是研究在芬兰血糖控制不佳的2型糖尿病患者中，CSII与MDI相比的长期成本效益。
方法
基于OpT2mise试验的临床输入数据，使用IQVIA核心糖尿病模型对2型糖尿病患者使用CSII的临床和经济结果进行长期预测。该试验表明，基线血糖控制不佳的患者使用CSII可使糖化血红蛋白（HbA1c）降低1.1%。分析从社会角度进行，时间范围为患者的一生。未来成本和临床结果按每年3%进行贴现。
结果
与MDI相比，持续皮下胰岛素输注可使质量调整预期寿命增加0.32个质量调整生命年（QALY）（分别为8.15和7.83个QALY），同时平均终身成本更高，导致CSII与MDI相比每获得一个QALY的增量成本效益比为47,834欧元。CSII组较高的治疗成本因糖尿病相关并发症成本降低15%而部分得到缓解。敏感性分析表明，CSII在基线HbA1c值最高的患者中最具成本效益。
结论
在芬兰，对于尽管优化了MDI但血糖控制不佳的2型糖尿病患者，CSII可能是一种具有成本效益的治疗选择。在此类患者中，与MDI相比，CSII可改善临床结果，较高的购置成本部分被较低的终身糖尿病相关并发症发生率和成本所抵消。
资助
美敦力国际公司。
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