NHTA, Copenhagen, Denmark.
Novo Nordisk Denmark A/S, Copenhagen, Denmark.
Curr Med Res Opin. 2021 Jun;37(6):949-956. doi: 10.1080/03007995.2021.1904863. Epub 2021 Mar 30.
To evaluate the economic burden associated with therapeutic inertia in patients with type 2 diabetes mellitus (T2D) in Denmark.
The economic burden for a newly diagnosed Danish T2D population was estimated using a validated diabetes model (The Swedish Institute for Health Economics (IHE) Cohort model), based on achieving varying levels of glycemic control. The analyses were based on clinical data from the Danish Centre for Strategic Research (DD2) and supplemented with relevant Swedish data where variables were missing. The analysis estimated the economic burden for populations achieving different guideline-recommended targets for glycated hemoglobin (HbA) and for a number of therapeutic inertia scenarios. To estimate the population-level burden Danish specific epidemiology data were incorporated. All costs are reported in 2020 Danish kroner (DKK) and 2020 Euros (€).
The baseline HbA level used for this analysis was 7.9% (63 mmol/mol), which was observed in newly diagnosed Danish T2D patients prior to their first anti-diabetic treatment. Therapeutic inertia was associated with substantial economic burden compared to achieving immediate glycemic control (target < 6.5% (< 48 mmol/mol)). Per patient burdens were between 3562 DKK and 20,160 DKK (€477- €2701) dependent on the duration of therapeutic inertia (1-7 years), with this further increased when indirect costs were included (9649 DKK to 51,585 DKK [€1393-€6912]). The economic burden at a population level was between 27 million DKK to 150 million DKK (€3.6 million to €20 million), dependent on the duration of therapeutic inertia, rising to 72 million DKK to 384 million DKK (€9.6 million to €51.4 million) when indirect costs were included.
Achieving early and intensive glycemic control, thereby minimizing therapeutic inertia can lead to substantial savings for the Danish society, ranging between 72 million DKK and 384 million DKK (€9.6 million to €51.4 million) (1-7 years of therapeutic inertia). This study highlights that efforts to minimize therapeutic inertia, by securing timely intensification before individual HbA targets are exceeded, results in significant long-term cost savings in Denmark.
评估丹麦 2 型糖尿病（T2D）患者治疗惰性相关的经济负担。
使用经过验证的糖尿病模型（瑞典健康经济研究所（IHE）队列模型），根据不同的血糖控制水平，估算新诊断的丹麦 T2D 人群的经济负担。分析基于丹麦战略研究中心（DD2）的临床数据，并在变量缺失的情况下补充相关的瑞典数据。分析估计了达到糖化血红蛋白（HbA）不同指南推荐目标以及一系列治疗惰性情况下的人群经济负担。为了估计人群负担，纳入了丹麦特定的流行病学数据。所有成本均以 2020 年丹麦克朗（DKK）和 2020 年欧元（€）报告。
本分析使用的基线 HbA 水平为 7.9%（63mmol/mol），这是新诊断的丹麦 T2D 患者在首次接受抗糖尿病治疗前的水平。与立即控制血糖（目标<6.5%（<48mmol/mol））相比，治疗惰性与大量经济负担相关。每位患者的负担在 3562 DKK 至 20160 DKK（€477-€2701）之间，具体取决于治疗惰性的持续时间（1-7 年），当包括间接成本时，这一数字进一步增加（9649 DKK 至 51585 DKK [€1393-€6912]）。人群层面的经济负担在 2700 万丹麦克朗至 1.5 亿丹麦克朗（€3600 万至 2000 万欧元）之间，具体取决于治疗惰性的持续时间，当包括间接成本时，上升至 7200 万丹麦克朗至 3.84 亿丹麦克朗（€9600 万至 5.14 亿欧元）。
实现早期和强化血糖控制，从而最大限度地减少治疗惰性，可以为丹麦社会带来 7200 万丹麦克朗至 3.84 亿丹麦克朗（€9600 万至 5.14 亿欧元）的显著长期成本节约（1-7 年的治疗惰性）。本研究强调，通过在个体 HbA 目标超过之前确保及时强化治疗，努力减少治疗惰性，可以在丹麦带来显著的长期成本节约。
