用于治疗二甲双胍单药治疗失败的2型糖尿病患者的胰高血糖素样肽1激动剂：经济评估研究的系统评价和荟萃分析
Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies.
作者信息
Bagepally Bhavani Shankara, Chaikledkaew Usa, Gurav Yogesh Krishnarao, Anothaisintawee Thunyarat, Youngkong Sitaporn, Chaiyakunapruk Nathorn, McEvoy Mark, Attia John, Thakkinstian Ammarin
机构信息
Non-Communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India.
Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand.
出版信息
BMJ Open Diabetes Res Care. 2020 Jul;8(1). doi: 10.1136/bmjdrc-2019-001020.
OBJECTIVES
To conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure.
RESEARCH DESIGN AND METHODS
The study design is a systematic review and meta-analysis. We searched MEDLINE (via PubMed), Scopus and Tufts Registry for eligible cost-utility studies up to June 2018, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We conducted a systematic review and pooled the INBs of GLP1s compared with other therapies in T2DM after metformin monotherapy failure. Various monetary units were converted to purchasing power parity, adjusted to 2017 US$. The INBs were calculated and then pooled across studies, stratified by level of country income; a random-effects model was used if heterogeneity was present, and a fixed-effects model if it was absent. Heterogeneity was assessed using Q test and I statistic.
RESULTS
A total of 56 studies were eligible, mainly from high-income countries (HICs). The pooled INBs of GLP1s compared with dipeptidyl peptidase-4 inhibitor (DPP4i) (n=10), sulfonylureas (n=6), thiazolidinedione (TZD) (n=3), and insulin (n=23) from HICs were US$4012.21 (95% CI US$-571.43 to US$8595.84, I=0%), US$3857.34 (95% CI US$-7293.93 to US$15 008.61, I=45.9%), US$37 577.74 (95% CI US$-649.02 to US$75 804.50, I=92.4%) and US$14 062.42 (95% CI US$8168.69 to US$19 956.15, I=86.4%), respectively. GLP1s were statistically significantly cost-effective compared with insulins, but not compared with DPP4i, sulfonylureas, and TZDs. Among GLP1s, liraglutide was more cost-effective compared with lixisenatide, but not compared with exenatide, with corresponding pooled INBs of US$4555.09 (95% CI US$3992.60 to US$5117.59, I=0) and US$728.46 (95% CI US$-1436.14 to US$2893.07, I=0), respectively.
CONCLUSION
GLP1 agonists are a cost-effective choice compared with insulins, but not compared with DPP4i, sulfonylureas and TZDs.
PROSPERO REGISTRATION NUMBER
CRD42018105193.
目的
进行一项系统评价和荟萃分析，汇总在二甲双胍单药治疗失败后，与其他疗法相比，胰高血糖素样肽-1（GLP1）在2型糖尿病（T2DM）中的增量净效益（INB）。
研究设计与方法
本研究设计为系统评价和荟萃分析。我们检索了MEDLINE（通过PubMed）、Scopus和塔夫茨注册库，以查找截至2018年6月符合条件的成本效用研究，遵循系统评价和荟萃分析的首选报告项目指南。我们进行了一项系统评价，并汇总了在二甲双胍单药治疗失败后，T2DM中GLP1与其他疗法相比的INB。将各种货币单位转换为购买力平价，并调整为2017年美元。计算INB，然后按国家收入水平进行分层，在各项研究中汇总；如果存在异质性，则使用随机效应模型，如果不存在异质性，则使用固定效应模型。使用Q检验和I统计量评估异质性。
结果
共有56项研究符合条件，主要来自高收入国家（HIC）。来自HIC的GLP1与二肽基肽酶-4抑制剂（DPP4i）（n = 10）、磺脲类药物（n = 6）、噻唑烷二酮（TZD）（n = 3）和胰岛素（n = 23）相比，汇总的INB分别为4012.21美元（95%CI：-571.43美元至8595.84美元，I = 0%）、3857.34美元（95%CI：-7293.93美元至15008.61美元，I = 45.9%）、37577.74美元（95%CI：-649.02美元至75804.50美元，I = 92.4%）和14062.42美元（95%CI：8168.69美元至19956.15美元，I = 86.4%）。与胰岛素相比，GLP1在统计学上具有显著的成本效益，但与DPP4i、磺脲类药物和TZD相比则不然。在GLP1中，与利司那肽相比，利拉鲁肽更具成本效益，但与艾塞那肽相比则不然，相应的汇总INB分别为4555.09美元（95%CI：3992.60美元至5117.59美元，I = 0）和-728.46美元（95%CI：-1436.14美元至2893.07美元，I = 0）。
结论
与胰岛素相比，GLP1激动剂是一种具有成本效益的选择，但与DPP4i、磺脲类药物和TZD相比则不然。
PROSPERO注册号：CRD42018105193。
Zotero 插件