Fraser Health Division of Endocrinology, 902-13737 96th Avenue, Surrey, BC, V3V 0C6, Canada.
Novo Nordisk Canada Inc., 2476 Argentia Rd, Mississauga, ON, L5N 6M1, Canada.
Appl Health Econ Health Policy. 2022 Jul;20(4):543-555. doi: 10.1007/s40258-022-00726-z. Epub 2022 Mar 28.
Our objective was to evaluate the long-term cost-effectiveness of once-weekly semaglutide 1 mg versus once-daily canagliflozin 300 mg in patients with type 2 diabetes mellitus (T2DM) uncontrolled with metformin from the healthcare payer and societal perspectives in Canada.
Head-to-head data from the SUSTAIN 8 randomised trial (NCT03136484) were extrapolated over 40 years using economic simulation modelling. The cost-effectiveness of once-weekly semaglutide 1 mg versus canagliflozin 300 mg for treating T2DM was estimated using the Swedish Institute for Health Economics-Diabetes Cohort Model (IHE-DCM) and the Economic and Health Outcomes Model of T2DM (ECHO-T2DM). Unit costs and disutility weights capturing treatments and key macro- and microvascular complications were sourced from the literature to best match the Canadian setting. A probabilistic base-case simulation and sensitivity analyses were conducted.
Once-weekly semaglutide 1 mg was associated with reductions in macro- and microvascular complications, yielding incremental cost-effectiveness ratios (ICERs) of (Canadian dollars [CAD]) CAD16,392 and 18,098 per incremental quality-adjusted life-year (QALY) gained versus canagliflozin 300 mg for IHE-DCM and ECHO-T2DM, respectively, from a healthcare payer perspective. Accounting for productivity loss as well, ICERs were CAD14,127 and 13,188 per QALY gained for IHE-DCM and ECHO-T2DM, respectively, from a societal perspective. Sensitivity analyses confirmed that the base-case results were robust to changes in input parameters and assumptions used.
At a willingness-to-pay threshold of CAD50,000 per QALY gained, once-weekly semaglutide 1 mg was cost-effective over 40 years versus once-daily canagliflozin 300 mg for the treatment of T2DM in patients failing to maintain glycemic control with metformin alone.
本研究旨在从加拿大医保支付方和全社会角度，评估每周一次司美格鲁肽 1mg 对比每日一次卡格列净 300mg 治疗二甲双胍控制不佳的 2 型糖尿病（T2DM）患者的长期成本效果。
采用经济模拟模型对 SUSTAIN 8 随机试验（NCT03136484）的头对头数据进行 40 年的外推。使用瑞典卫生经济学-糖尿病队列模型（IHE-DCM）和 2 型糖尿病经济和健康结局模型（ECHO-T2DM），评估每周一次司美格鲁肽 1mg 对比卡格列净 300mg 治疗 T2DM 的成本效果。从文献中获取治疗和主要大血管及微血管并发症的单位成本和失能权重，以最好地匹配加拿大的情况。进行了概率性基础案例模拟和敏感性分析。
每周一次司美格鲁肽 1mg 可降低大血管和微血管并发症，使得与卡格列净 300mg 相比，医保支付方视角下 IHE-DCM 和 ECHO-T2DM 的增量成本效果比（ICER）分别为每增加 1 个质量调整生命年（QALY）多花费 CAD16392 和 CAD18098；考虑到生产力损失，IHE-DCM 和 ECHO-T2DM 的 ICER 分别为每增加 1 个 QALY 多花费 CAD14127 和 CAD13188。敏感性分析证实，基础案例结果对输入参数和假设的变化具有稳健性。
每周一次司美格鲁肽 1mg 在医保支付方视角下，40 年内对于单独使用二甲双胍血糖控制不佳的 T2DM 患者，其成本效果优于每日一次卡格列净 300mg，其治疗阈值为每获得 1 个 QALY 多花费 CAD50000。
