Torre Enrico, Bruno Giacomo M, Di Matteo Sergio, Martinotti Chiara, Valentino Maria Chiara, Bottaro Luigi C, Colombo Giorgio L
Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy.
S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy.
Clinicoecon Outcomes Res. 2020 Apr 8;12:177-189. doi: 10.2147/CEOR.S240183. eCollection 2020.
Diabetes represents a relevant public health problem worldwide due to its growing prevalence and socioeconomic burden, principally due to the development of macrovascular and microvascular complications as well as to the continuous launch of new and even more expensive drugs. The aim of our study is to evaluate the economic impact of dulaglutide, a weekly GLP-1 receptor agonist, on the treatment of diabetic patients as an alternative to both high dose sulphonylureas and insulin basalization at the failure of oral therapies alone. We carried out a cost-effectiveness analysis developed considering the economic implications of recent clinical studies regarding cardiovascular risk drug effects and especially of REWIND studies outcomes, focusing on the impact of weight changes on HRQoL.
In our analysis, we have applied the cost-utility technique to the above reported clinical outcomes and compared the global costs of dulaglutide versus sulfonylurea or basal insulin, all in add-on with metformin. We have chosen gliclazide, as a sulfonylurea and Abasaglar, the less expensive among basal insulin analogues. Abasaglar was titrated to 20 IU, corresponding to the mean dosage used in the treatment of type II diabetic patients. The model aims to estimate total direct costs related to the above-reported treatments and find out the real gap in costs between dulaglutide, the apparently cheaper gliclazide and basal insulin glargine (IGlargine) based on the Italian National Healthcare System (INHS).
The total cost of dulaglutide has resulted in €859.66 higher than gliclazide (€1,579.73 vs €720.07) and basal insulin, although less significantly, reporting a difference of €396.54 (€1,579.73 vs 1,183.19). Except for the purchase cost, dulaglutide has reported reduced costs compared to insulin IGlargine and gliclazide. Dulaglutide showed lower self-monitoring blood glucose and hypoglycaemia costs, a significant reduction in costs related to cardiovascular complications, as well as savings in costs in other drugs. Dulaglutide can be considered a cost-effective antidiabetic therapy, due to the positive impact on the quality of life induced by weight reduction, despite the higher annual cost per patient, mainly influenced by drug purchase cost.
In this cost-utility analysis, dulaglutide has shown to be a cost-effective treatment option from the Italian healthcare system perspective as add-on therapy to metformin in patients with inadequately controlled type 2 diabetes mellitus. Study findings can provide stakeholders valuable evidence to support the adoption of this cost-effective second- or third-line therapy compared to gliclazide or basal insulin glargine. Dulaglutide cost-effectiveness has been particularly evident in the comparison with basal insulin glargine, indicating that, in patients who have treatment indication, this therapy may be preferred to basalization avoiding related complications and costs.
糖尿病在全球范围内是一个重大的公共卫生问题，因其患病率不断上升且社会经济负担加重，主要原因是大血管和微血管并发症的发生以及新的、甚至更昂贵药物的不断推出。我们研究的目的是评估每周一次的胰高血糖素样肽-1（GLP-1）受体激动剂度拉糖肽对糖尿病患者治疗的经济影响，作为口服治疗失败时高剂量磺脲类药物和基础胰岛素治疗的替代方案。我们进行了一项成本效益分析，考虑了近期关于心血管风险药物效应的临床研究，特别是REWIND研究结果的经济影响，重点关注体重变化对健康相关生活质量（HRQoL）的影响。
在我们的分析中，我们将成本效用技术应用于上述临床结果，并比较了度拉糖肽与磺脲类药物或基础胰岛素的总体成本，所有这些药物均与二甲双胍联合使用。我们选择了格列齐特作为磺脲类药物，以及基础胰岛素类似物中较便宜的阿必鲁泰。阿必鲁泰滴定至20 IU，相当于治疗II型糖尿病患者时使用的平均剂量。该模型旨在估计与上述治疗相关的总直接成本，并根据意大利国家医疗保健系统（INHS）找出度拉糖肽、明显较便宜的格列齐特和甘精胰岛素（IGlargine）之间的实际成本差距。
度拉糖肽的总成本比格列齐特（1579.73欧元对720.07欧元）和基础胰岛素高出859.66欧元，尽管差异不太显著，相差396.54欧元（1579.73欧元对1183.19欧元）。除了购买成本外，度拉糖肽与甘精胰岛素和格列齐特相比成本有所降低。度拉糖肽显示出较低的自我血糖监测和低血糖成本，心血管并发症相关成本显著降低，以及其他药物成本的节省。尽管每位患者的年度成本较高，主要受药物购买成本影响，但度拉糖肽由于体重减轻对生活质量产生的积极影响，可被视为一种具有成本效益的抗糖尿病治疗方法。
在这项成本效用分析中，从意大利医疗保健系统的角度来看，度拉糖肽作为二甲双胍的附加疗法，已被证明是治疗控制不佳的2型糖尿病患者的一种具有成本效益的治疗选择。研究结果可为利益相关者提供有价值的证据，以支持采用这种具有成本效益的二线或三线疗法，而不是格列齐特或甘精胰岛素。度拉糖肽的成本效益在与甘精胰岛素的比较中尤为明显，表明在有治疗指征的患者中，这种疗法可能比基础胰岛素治疗更可取，可避免相关并发症和成本。
