Martín Virginia, Vidal Josep, Malkin Samuel J P, Hallén Nino, Hunt Barnaby
Novo Nordisk Pharma SA, Madrid, Spain.
Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain.
Adv Ther. 2020 Oct;37(10):4427-4445. doi: 10.1007/s12325-020-01464-1. Epub 2020 Aug 29.
Healthcare systems aim to maximize the health of the population, but must work within constrained budgets. Therefore, choosing therapies that are both effective and cost-effective is paramount. The present analysis assessed the cost-effectiveness of once-weekly semaglutide 0.5 mg and 1 mg versus once-weekly dulaglutide 1.5 mg and versus once daily sitagliptin 100 mg for the treatment of patients with type 2 diabetes with inadequate glycemic control on oral anti-hyperglycemic medications over patient lifetimes from a healthcare payer perspective in the Spanish setting.
Cost and clinical outcomes were projected over patient lifetimes using the IQVIA CORE Diabetes Model. Baseline cohort characteristics and treatment effects on initiation of semaglutide 0.5 mg and 1 mg, dulaglutide 1.5 mg and sitagliptin 100 mg were based on the once-weekly semaglutide clinical trial program (SUSTAIN 7 and 2). Captured costs included treatment costs and costs of diabetes-related complications. Projected outcomes were discounted at 3.0% annually.
Projections of long-term clinical outcomes indicated that once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in discounted life expectancy of 0.02 and 0.11 years, respectively, and discounted quality-adjusted life expectancy of 0.03 and 0.11 quality-adjusted life years (QALYs), respectively, versus dulaglutide 1.5 mg. Compared with sitagliptin, once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in discounted life expectancy of 0.17 and 0.24 years, respectively and discounted quality-adjusted life expectancy of 0.16 and 0.23 QALYs. The increased duration and quality of life with once-weekly semaglutide 0.5 mg and 1 mg resulted from a reduced cumulative incidence and delayed time to onset of diabetes-related complications. Avoided complications resulted in once-weekly semaglutide 0.5 mg and 1 mg being cost-saving versus dulaglutide 1.5 mg and versus sitagliptin 100 mg from a healthcare payer perspective.
Once-weekly semaglutide 0.5 mg and 1 mg were considered dominant (more effective and less costly) versus sitagliptin 100 mg and dulaglutide 1.5 mg for the treatment of patients with type 2 diabetes with inadequate glycemic control on oral anti-hyperglycemic medications and are likely to be a good use of healthcare resources in the Spanish setting.
医疗保健系统旨在使人群健康最大化，但必须在预算受限的情况下运作。因此，选择既有效又具有成本效益的治疗方法至关重要。本分析从西班牙医疗保健支付方的角度，评估了每周一次皮下注射司美格鲁肽0.5毫克和1毫克、每周一次度拉糖肽1.5毫克以及每日一次西格列汀100毫克，在口服降糖药物血糖控制不佳的2型糖尿病患者的终生治疗中的成本效益。
使用艾昆纬CORE糖尿病模型预测患者终生的成本和临床结果。司美格鲁肽0.5毫克和1毫克、度拉糖肽1.5毫克以及西格列汀100毫克起始治疗的基线队列特征和治疗效果基于每周一次皮下注射司美格鲁肽临床试验项目（SUSTAIN 7和2）。所涵盖的成本包括治疗成本和糖尿病相关并发症的成本。预测结果按每年3.0%进行贴现。
长期临床结果预测表明，与度拉糖肽1.5毫克相比，每周一次皮下注射司美格鲁肽0.5毫克和1毫克分别使贴现预期寿命提高0.02年和0.11年，贴现质量调整预期寿命分别提高0.03个和0.11个质量调整生命年（QALY）。与西格列汀相比，每周一次皮下注射司美格鲁肽0.5毫克和1毫克分别使贴现预期寿命提高0.17年和0.24年，贴现质量调整预期寿命分别提高0.16个和0.23个QALY。每周一次皮下注射司美格鲁肽0.5毫克和1毫克使生活持续时间和质量增加，这是由于糖尿病相关并发症的累积发病率降低和发病时间延迟。从医疗保健支付方的角度来看，避免的并发症使每周一次皮下注射司美格鲁肽0.5毫克和1毫克相对于度拉糖肽1.5毫克和西格列汀100毫克具有成本节约效益。
对于口服降糖药物血糖控制不佳的2型糖尿病患者，每周一次皮下注射司美格鲁肽0.5毫克和1毫克相对于西格列汀100毫克和度拉糖肽1.5毫克被认为具有优势（更有效且成本更低），在西班牙环境下可能是医疗资源的良好利用方式。
