Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Pharmacy, Mindong Hospital of Ningde City, Fu'an, China.
Front Endocrinol (Lausanne). 2021 Aug 13;12:684960. doi: 10.3389/fendo.2021.684960. eCollection 2021.
Dipeptidylpeptidase-4 (DPP-4) inhibitors, including linagliptin, alogliptin, saxagliptin, sitagliptin, and vildagliptin, are used for the treatment of type 2 diabetes mellitus (T2DM) patients in China. This study assessed the economic outcomes of different DPP-4 inhibitors in patients with T2DM inadequately controlled with metformin in the Chinese context.
In this study, the validated Chinese Outcomes Model for T2DM (COMT) was conducted to project economic outcomes from the perspective of Chinese healthcare service providers. Efficacy and safety, medical expenditure, and utility data were derived from the literature, which were assigned to model variables. The primary outputs of the model included the lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). One-way and probability sensitivity analysis was conducted to assess the potential uncertainties of parameters.
Of the five competing strategies, alogliptin 25 mg strategy yielded the most significant health outcome, which associated with improvements in discounted QALY of 0.007, 0.014, 0.011, and 0.022 linagliptin 5 mg, saxagliptin 5 mg, sitagliptin 100 mg and vildagliptin50 mg, respectively. The sitagliptin 100 mg strategy was the cheapest option. The ICER of alogliptin 25 mg against sitagliptin 100 mg strategy was $6,952 per additional QALY gained, and the rest of the strategies were dominated or extended dominated. The most influential parameters were the cost of DPP-4 inhibitors and their treatment efficacy.
These results suggested that alogliptin was a preferred treatment option compared with other DPP-4 inhibitors for Chinese patients whose T2DM are inadequately controlled on metformin monotherapy.
二肽基肽酶-4（DPP-4）抑制剂，包括利拉利汀、阿格列汀、沙格列汀、西他列汀和维格列汀，在中国用于治疗 2 型糖尿病（T2DM）患者。本研究评估了不同 DPP-4 抑制剂在二甲双胍治疗控制不佳的中国 T2DM 患者中的经济学结局。
本研究中，采用经过验证的中国 2 型糖尿病结局模型（COMT），从中国医疗保健服务提供者的角度预测经济结局。疗效和安全性、医疗支出和效用数据源自文献，分配给模型变量。模型的主要输出包括终生成本、质量调整生命年（QALY）和增量成本效益比（ICER）。进行了单因素敏感性分析和概率敏感性分析，以评估参数的潜在不确定性。
在五种竞争策略中，阿格列汀 25mg 策略产生了最显著的健康结果，与利拉利汀 5mg、沙格列汀 5mg、西他列汀 100mg 和维格列汀 50mg 策略相比，分别改善了折扣 QALY 0.007、0.014、0.011 和 0.022。西他列汀 100mg 策略成本最低。阿格列汀 25mg 策略与西他列汀 100mg 策略相比，每获得额外一个 QALY 的增量成本效益比为 6952 美元，其余策略均为劣势或扩展劣势。最具影响力的参数是 DPP-4 抑制剂的成本及其治疗效果。
这些结果表明，与其他 DPP-4 抑制剂相比，阿格列汀是二甲双胍单药治疗控制不佳的中国患者的首选治疗方案。
