Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA.
The George Institute for Global Health, University of New South Wales, Kensington, NSW, 2042, Australia.
Pharmacoeconomics. 2019 Jun;37(6):777-818. doi: 10.1007/s40273-019-00774-9.
This study aimed to systematically review cost-effectiveness studies of newer antidiabetic medications.
The PubMed/MEDLINE, EMBASE, CINAHL Plus, Cochrane Library-NHS Economic Evaluation Database (Wiley), Cochrane Library-Health Technology Assessment Database (Wiley), Cochrane Library-Database of Abstracts of Reviews of Effects (Wiley), and the Cost-Effectiveness Analysis Registry databases (from 1 January 2000 to 1 June 2018) were searched. The search strategies included the Medical Subject Heading (MeSH) term 'economics', and the MeSH entry terms 'cost', 'cost effectiveness', 'value', and 'cost utility', as well as all names for GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors. Inclusion criteria included (1) cost-effectiveness studies of the newer antidiabetic medications, including sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors; and (2) full-text publications in English. Two reviewers independently screened the titles, abstracts, and full-text articles to select studies for data extraction. Discrepancies were resolved by discussion and consensus. The quality of reporting cost-effectiveness analyses was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guideline.
Among 85 studies selected, 82 clearly stated the types of diabetes model used (e.g. CORE model), and 70 studied used validated diabetes models. Seventy-four (87%) studies were funded by pharmaceutical companies, and 72 (85%) studies were conducted from a payer's perspective. Seventy-six (89%) studies presented were of good quality (20-24 CHEERS items), and nine were of moderate quality (14-19 items). Thirty studies compared newer antidiabetic medications with insulin, 3 studies compared newer antidiabetic medications with thiazolidinediones (TZDs), 15 studies compared newer antidiabetic medications with sulfonylureas, 40 studies compared new antidiabetic medications with alternative newer antidiabetic medication, and 9 studies compared other antidiabetic agents that were not included above. Newer antidiabetic medications were reported to be cost-effective in 26 of 30 (87%) studies compared with insulin, and 13 of 15 (87%) studies compared with sulfonylureas.
Most economic evaluations of antidiabetic medications have good reporting quality and use validated diabetes models. The newer antidiabetic medications in most of the reviewed studies were found to be cost effective, compared with insulin, TZDs, and sulfonylureas.
本研究旨在系统评价新型抗糖尿病药物的成本效益研究。
检索了 PubMed/MEDLINE、EMBASE、CINAHL Plus、Cochrane 图书馆-NHS 经济评价数据库（Wiley）、Cochrane 图书馆-卫生技术评估数据库（Wiley）、Cochrane 图书馆-效果评价文摘数据库（Wiley）和成本效益分析登记处数据库（2000 年 1 月 1 日至 2018 年 6 月 1 日）。搜索策略包括医学主题词（MeSH）术语“经济学”以及 MeSH 条目“成本”、“成本效益”、“价值”和“成本效用”，以及 GLP-1 受体激动剂、DPP-4 抑制剂和 SGLT2 抑制剂的所有名称。纳入标准包括（1）新型抗糖尿病药物的成本效益研究，包括钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂、胰高血糖素样肽-1（GLP-1）受体激动剂和二肽基肽酶-4（DPP-4）抑制剂；（2）英文全文出版物。两名评审员独立筛选标题、摘要和全文文章，以选择用于数据提取的研究。通过讨论和达成共识解决分歧。使用健康经济评估报告标准（CHEERS）指南评估成本效益分析报告的质量。
在 85 项选定的研究中，82 项明确说明了使用的糖尿病模型类型（例如 CORE 模型），70 项研究使用了经过验证的糖尿病模型。74 项（87%）研究由制药公司资助，72 项（85%）研究从支付者的角度进行。76 项（89%）提出的研究质量良好（20-24 CHEERS 项目），9 项为中等质量（14-19 项）。30 项研究比较了新型抗糖尿病药物与胰岛素的疗效，3 项研究比较了新型抗糖尿病药物与噻唑烷二酮类药物（TZDs）的疗效，15 项研究比较了新型抗糖尿病药物与磺酰脲类药物的疗效，40 项研究比较了新型抗糖尿病药物与其他新型抗糖尿病药物的疗效，9 项研究比较了其他未包括在上述药物中的抗糖尿病药物。与胰岛素相比，新型抗糖尿病药物在 30 项研究中的 26 项（87%）研究中被报道为具有成本效益，与磺酰脲类药物相比，在 15 项研究中的 13 项（87%）研究中被报道为具有成本效益。
大多数抗糖尿病药物的经济评估报告质量良好，并且使用了经过验证的糖尿病模型。在大多数研究中，与胰岛素、TZDs 和磺酰脲类药物相比，新型抗糖尿病药物被认为具有成本效益。
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