Ehlers Lars H, Lamotte Mark, Ramos Mafalda C, Sandgaard Susanne, Holmgaard Pia, Kristensen Malene M, Ejskjaer Niels
Department of Clinical Medicine, Aalborg University, Ålborg, Denmark.
IQVIA Global IQVIA, Da Vincilaan 7, 1930, Zaventem, Belgium.
Diabetes Ther. 2022 Mar;13(3):489-503. doi: 10.1007/s13300-022-01221-3. Epub 2022 Feb 21.
International and Danish guidelines recommend the use of glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter 2 (SGLT-2) inhibitors already in second line in the management of type 2 diabetes (T2D). The objective of this study was to evaluate the long-term cost-effectiveness (CE) of subcutaneous (SC) semaglutide (GLP-1 RA) versus empagliflozin (SGLT-2 inhibitor) in individuals with T2D uncontrolled on metformin alone from a Danish payer's perspective.
Cost-effectiveness analyses (CEA) were conducted from a Danish payer's perspective, using the IQVIA Core Diabetes model (CDM 9.5), with a time horizon of 50 years and an annual discount of 4% on costs and effects. Patients received either SC semaglutide or empagliflozin, in addition to metformin, until HbA1c threshold of 7.5% (58 mmol/mol) was reached, following which treatment intensification with insulin glargine in addition to empagliflozin or SC semaglutide plus metformin was considered. Baseline cohort characteristics and treatment effects were sourced from a published CEA. Utilities and cost of diabetes-related complications were also obtained from published sources. Treatment costs were derived from Danish official sources. Scenario analyses were also performed to test the accuracy of the base case results.
Individuals with T2D on SC semaglutide plus metformin gained 0.065 life-years (LYs) and 0.130 quality-adjusted LYs (QALYs), respectively, at an incremental cost of DKK 96,923 (€ 13,031) compared to empagliflozin plus metformin, resulting in an incremental cost-effectiveness ratio (ICER) of DKK 745,561(€ 100,239) per QALY gained. The probabilistic sensitivity analysis (PSA) results showed that the SC semaglutide plus metformin was cost-effective in 19% of simulations assuming a willingness-to-pay (WTP) threshold of DKK 357,100 (€ 48,011)/QALY gained. Duration of therapy with SC semaglutide seems the key driver of results.
The current analyses suggest that SC semaglutide plus metformin is not cost-effective compared to empagliflozin plus metformin from a Danish payer's perspective.
国际和丹麦的指南建议，在2型糖尿病（T2D）的管理中，胰高血糖素样肽1受体激动剂（GLP-1 RA）和钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂在二线治疗中即可使用。本研究的目的是从丹麦医保支付方的角度，评估皮下注射司美格鲁肽（GLP-1 RA）与恩格列净（SGLT-2抑制剂）相比，在仅使用二甲双胍血糖控制不佳的T2D患者中的长期成本效益（CE）。
从丹麦医保支付方的角度进行成本效益分析（CEA），使用艾昆纬核心糖尿病模型（CDM 9.5），时间跨度为50年，成本和效果的年度贴现率为4%。患者在服用二甲双胍的基础上，接受皮下注射司美格鲁肽或恩格列净治疗，直至糖化血红蛋白（HbA1c）阈值达到7.5%（58 mmol/mol），之后考虑在恩格列净或皮下注射司美格鲁肽加二甲双胍的基础上加用甘精胰岛素强化治疗。基线队列特征和治疗效果来源于已发表的CEA。糖尿病相关并发症的效用值和成本也从已发表的资料中获取。治疗成本来自丹麦官方资料。还进行了情景分析以检验基础病例结果的准确性。
与恩格列净加二甲双胍相比，皮下注射司美格鲁肽加二甲双胍的T2D患者分别多获得0.065个生命年（LYs）和0.130个质量调整生命年（QALYs），增量成本为96,923丹麦克朗（13,031欧元），每获得一个QALY的增量成本效益比（ICER）为745,561丹麦克朗（100,239欧元）。概率敏感性分析（PSA）结果显示，假设支付意愿（WTP）阈值为357,100丹麦克朗（48,011欧元）/获得的QALY，在19%的模拟中，皮下注射司美格鲁肽加二甲双胍具有成本效益。皮下注射司美格鲁肽的治疗持续时间似乎是结果的关键驱动因素。
当前分析表明，从丹麦医保支付方的角度来看，皮下注射司美格鲁肽加二甲双胍与恩格列净加二甲双胍相比不具有成本效益。
