Al Jalila Children's Hospital, Dubai, United Arab Emirates.
Novo Nordisk A/S, Søborg, Denmark.
BMJ Open Diabetes Res Care. 2019 Sep 3;7(1):e000664. doi: 10.1136/bmjdrc-2019-000664. eCollection 2019.
With healthcare systems under increasing financial pressure from costs associated with diabetes care, it is important to assess which treatments provide clinical benefits and represent best value. This study evaluated the annual costs of insulin degludec (degludec) versus insulin detemir (IDet) in children and adolescents with type 1 diabetes (T1D) in the UK.
Using data from a randomized, treat-to-target, non-inferiority trial-BEGIN YOUNG 1-annual costs with degludec versus IDet in children and adolescents aged 1-17 years with T1D were estimated, as costs of these insulins and hyperglycemia with ketosis events. Analyses by age group (1-5, 6-11 and 12-17 years) and scenario (no ketosis benefit, no dose benefit, hyperglycemia with ketones >0.6 and >3.0 mmol/L and the additional costs of twice-daily IDet in 64% of patients) were also performed.
The mean annual cost per patient was estimated as £235.16 for degludec vs £382.91 for IDet, resulting in an annual saving of £147.75 per patient. These substantial cost savings were driven by relative reductions in the frequency of hyperglycemia with ketosis and basal insulin dose with degludec versus IDet. Annual savings in favor of degludec were observed across each age group (£122.63, £140.59 and £172.50 for 1-5, 6-11 and 12-17 years age groups, respectively). Five scenario analyses further demonstrated the robustness of the results, which included no ketosis or dose benefits in favor of degludec.
Degludec provides appreciable annual cost savings compared with IDet in children and adolescents with T1D in a UK setting. While a cost-effectiveness analysis could incorporate the health impact of treatment complications better than the present cost analysis, the strong generalizability of the data from this study suggests that degludec can help healthcare providers to maximize health outcomes despite increasingly stringent budgets.
随着医疗保健系统面临与糖尿病治疗相关成本的越来越大的财务压力，评估哪些治疗方法具有临床益处并代表最佳价值非常重要。本研究评估了在英国，1 型糖尿病（T1D）儿童和青少年中，胰岛素德谷胰岛素（degludec）与胰岛素地特胰岛素（IDet）的年度成本。
使用来自一项随机、靶向治疗、非劣效性试验-BEGIN YOUNG 1 的数据，估算了德谷胰岛素与 IDet 在 1-17 岁 T1D 儿童和青少年中的年度成本，包括这些胰岛素和高血糖症与酮症事件的成本。还按年龄组（1-5 岁、6-11 岁和 12-17 岁）和方案（无酮症获益、无剂量获益、血糖 >0.6 和 >3.0mmol/L 伴酮症、64%的患者中每天两次 IDet 的额外成本）进行分析。
估计每位患者的年平均成本为德谷胰岛素 235.16 英镑，IDet 为 382.91 英镑，每位患者每年节省 147.75 英镑。这些大量的成本节约主要归因于与 IDet 相比，德谷胰岛素可降低血糖伴酮症和基础胰岛素剂量的发生频率。在每个年龄组中，德谷胰岛素均具有成本节约优势（1-5 岁、6-11 岁和 12-17 岁年龄组分别为 122.63、140.59 和 172.50 英镑）。五种方案分析进一步证明了结果的稳健性，其中包括德谷胰岛素无酮症或剂量获益。
在英国 T1D 儿童和青少年中，与 IDet 相比，德谷胰岛素可提供可观的年度成本节约。虽然成本效益分析可以比当前的成本分析更好地纳入治疗并发症的健康影响，但本研究数据的强通用性表明，德谷胰岛素可以帮助医疗保健提供者在预算紧张的情况下最大限度地提高健康结果。
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