Endocrinology and Nutrition Unit, Hospital Torrecardenas, Clinica San Pedro, Almeria, Spain.
Diabetes Referral Unit, Hospital Clinico Universitario de Valencia, Valencia, Spain.
Diabetes Obes Metab. 2019 Jun;21(6):1349-1356. doi: 10.1111/dom.13660. Epub 2019 Mar 20.
To evaluate the long-term cost-effectiveness of fixed-ratio combination insulin degludec/liraglutide (IDegLira) versus comparator regimens for type 2 diabetes in Spain, based on real-world evidence.
Clinical data were taken from the European Xultophy Treatment Retrospective Audit (EXTRA) real-world evidence study in which patients failing to meet glycaemic targets were switched to IDegLira. Baseline regimens (prior to IDegLira treatment) were categorized as: multiple daily insulin injections (MDI; 28%); glucagon-like peptide-1 (GLP-1) receptor agonists in combination with insulin (24%); basal insulin (19%); GLP-1 receptor agonists (10%); and non-injectable medications (19%). The IQVIA CORE Diabetes Model was used to project long-term outcomes for patients switching to IDegLira or continuing their baseline regimens (excluding non-injectable regimens). Costs were accounted from a Spanish National Health System perspective. Future costs and clinical benefits were discounted at 3% annually and sensitivity analyses were performed.
IDegLira was projected to reduce the incidence of diabetes-related complications and improve quality-adjusted life expectancy versus all four comparators. IDegLira reduced direct medical costs versus GLP-1 receptor agonists in combination with insulin, and versus GLP-1 receptor agonist therapy, and was therefore considered dominant (cost saving while improving outcomes). IDegLira was found to be cost-effective versus MDI and basal insulin with incremental cost-effectiveness ratios of EUR 3013 per quality-adjusted life-year (QALY) gained and EUR 6890 per QALY gained, respectively.
Long-term projections based on real-world evidence indicated that IDegLira is likely to improve clinical outcomes and reduce costs or be cost-effective compared with other injectable regimens in people with type 2 diabetes in Spain.
基于真实世界证据，评估固定比例复方胰岛素德谷胰岛素/利拉鲁肽（IDegLira）与 2 型糖尿病对照治疗方案在西班牙的长期成本效益。
临床数据来自于欧洲 Xultophy 治疗回顾性审计（EXTRA）真实世界证据研究，该研究中，血糖控制不达标的患者换用 IDegLira。基线治疗方案（在接受 IDegLira 治疗之前）分为：每日多次胰岛素注射（MDI；28%）；胰高血糖素样肽-1（GLP-1）受体激动剂联合胰岛素（24%）；基础胰岛素（19%）；GLP-1 受体激动剂（10%）；以及非注射类药物（19%）。采用 IQVIA CORE 糖尿病模型预测换用 IDegLira 或继续其基线治疗方案（不包括非注射类方案）的患者的长期结局。从西班牙国家卫生系统角度计算成本。未来成本和临床获益按 3%贴现，进行敏感性分析。
与所有 4 种对照相比，IDegLira 预计可降低糖尿病相关并发症的发生率并提高质量调整预期寿命。与 GLP-1 受体激动剂联合胰岛素和 GLP-1 受体激动剂治疗相比，IDegLira 降低了直接医疗成本，因此被认为具有优势（在改善结局的同时降低成本）。与 MDI 和基础胰岛素相比，IDegLira 的增量成本效益比分别为每质量调整生命年（QALY）增加 3013 欧元和每 QALY 增加 6890 欧元，因此被认为具有成本效益。
基于真实世界证据的长期预测表明，与西班牙 2 型糖尿病患者的其他注射类方案相比，IDegLira 可能改善临床结局并降低成本或具有成本效益。
