Men Peng, Liu Tianbi, Zhai Suodi
Department of Pharmacy, Peking University Third Hospital, Beijing, People's Republic of China.
Institute for Drug Evaluation, Peking University Health Science Center, Beijing, People's Republic of China.
Diabetes Metab Syndr Obes. 2020 Aug 11;13:2823-2831. doi: 10.2147/DMSO.S266901. eCollection 2020.
To evaluate the cost-utility of empagliflozin, in addition to best available standard care (BASC), for the treatment of adult patients with T2DM at high cardiovascular risk from the Chinese healthcare system perspective.
A Microsoft Excel-based patient-level simulation model, based on the EMPA-REG OUTCOME trial data, was adapted and used to project individual's clinical and economic outcomes over a lifetime horizon. The cost and utility values were derived from databases and published studies. Numbers and rates of diabetes-related events, life-years (LYs), quality-adjusted life-years (QALYs), costs (¥ 2019) as well as incremental cost-utility ratios (ICURs) were calculated. Deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the model results.
Compared with BASC, empagliflozin plus BASC was predicted to result in an additional 1.01 QALYs (8.05 QALYs vs 7.04 QALYs) at an incremental cost of ¥4002 per patient. The modeled ICUR was ¥3988 per QALY gained, which was considered highly cost-effective in China compared to both one and three times the GDP per capita in 2019 (¥70,892 and ¥212,676). The deterministic and probabilistic sensitivity analyses confirmed the robustness of base-case results.
This is the first cost-utility analysis regarding the use of empagliflozin in patients with T2DM in China, the world's most affected country by the T2DM pandemic. The economic evaluation suggests that empagliflozin added to BASC was estimated to be a highly value-for-money option for the treatment of adult patients with T2DM at high cardiovascular risk in the Chinese healthcare setting.
从中国医疗保健系统的角度，评估在最佳可用标准治疗（BASC）基础上加用恩格列净治疗心血管风险高的成年2型糖尿病患者的成本效益。
基于恩格列净心血管结局研究（EMPA-REG OUTCOME）试验数据，采用基于Microsoft Excel的患者水平模拟模型，预测个体一生的临床和经济结局。成本和效用值来自数据库及已发表的研究。计算糖尿病相关事件的数量和发生率、生命年（LYs）、质量调整生命年（QALYs）、成本（2019年人民币）以及增量成本效益比（ICURs）。进行确定性和概率敏感性分析以检验模型结果的稳健性。
与BASC相比，预计恩格列净加BASC可使每位患者额外获得1.01个QALYs（8.05个QALYs对7.04个QALYs），增量成本为每人4002元。模拟的ICUR为每获得1个QALY 3988元，与2019年人均GDP的1倍和3倍（70892元和212676元）相比，在中国被认为具有很高的成本效益。确定性和概率敏感性分析证实了基础病例结果的稳健性。
这是中国（世界上受2型糖尿病大流行影响最严重的国家）首次对恩格列净用于2型糖尿病患者进行的成本效益分析。经济评估表明，在中国医疗环境中，在BASC基础上加用恩格列净估计是治疗心血管风险高的成年2型糖尿病患者性价比很高的选择。
