新型抗糖尿病药物作为 2 型糖尿病二线治疗的成本效益：系统评价。
Cost-Effectiveness of Newer Antidiabetic Drugs as Second-Line Treatment for Type 2 Diabetes: A Systematic Review.
机构信息
Department of Clinical Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310006, China.
Department of Pharmacy, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310002, China.
出版信息
Adv Ther. 2023 Oct;40(10):4216-4235. doi: 10.1007/s12325-023-02612-z. Epub 2023 Jul 29.
INTRODUCTION
Evidence from cardiovascular outcome trials (CVOTs) for newer antidiabetic drugs is increasingly influencing revised recommendations for second-line therapy in type 2 diabetes (T2D). This systematic review aimed to compare the cost-effectiveness of newer antidiabetic drugs specified as sodium-glucose cotransporter 2 inhibitor (SGLT2i), glucagon-like peptide 1 receptor agonist (GLP-1RA), and dipeptidyl peptidase 4 inhibitor (DPP-4i) for T2D in a second-line setting.
METHODS
A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, and all relevant published studies were searched comprehensively in electronic databases, including PubMed, Embase, Web of Science, and International Health Technology Assessment database published from April 2023. The quality of the included studies was evaluated using Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 reporting checklists.
RESULTS
We included 28 studies that met the inclusion criteria. Overall reporting of the identified studies largely met CHEERS 2022 recommendations. The CORE and Cardiff models were the most frequently utilized for pharmacoeconomic evaluation in T2D. Four studies consistently discovered that SGLT2i was more cost-effective than GLP-1RA in T2D who were not adequately controlled by metformin monotherapy. Four studies compared GLP-1RA with DPP-4i, sufonylurea (SU), or insulin. Except for one that demonstrated SU was cost-effective, all were GLP-1RA. Five studies revealed that SGLT2i was more cost-effective than DPP-4i or SU. Eleven studies indicated that DPP-4i was more cost-effective than traditional antidiabetic drugs. Four additional studies explored the cost-effectiveness of various antidiabetic drugs as second-line options, indicating that SU, SGLT2i, or meglitinides were more economically advantageous. The most common driven factors were the cost of new antidiabetic drugs.
CONCLUSION
Newer antidiabetic drugs as second line are the cost-effective option for T2D from the cost-effectiveness perspective, especially SGLT2i.
简介
越来越多的心血管结局试验（CVOTs）证据正影响 2 型糖尿病（T2D）二线治疗的修订建议。本系统评价旨在比较新型抗糖尿病药物（指定为钠-葡萄糖共转运蛋白 2 抑制剂 [SGLT2i]、胰高血糖素样肽 1 受体激动剂 [GLP-1RA] 和二肽基肽酶 4 抑制剂 [DPP-4i]）在二线治疗 T2D 中的成本效益。
方法
本系统评价按照系统评价的首选报告项目（PRISMA）指南进行，并全面搜索了电子数据库中的所有相关已发表研究，包括 PubMed、Embase、Web of Science 和国际卫生技术评估数据库，检索时间为 2023 年 4 月。使用综合健康经济评估报告标准（CHEERS）2022 报告清单评估纳入研究的质量。
结果
我们纳入了 28 项符合纳入标准的研究。总体而言，纳入研究的报告在很大程度上符合 CHEERS 2022 建议。在 T2D 中，COREE 和加的夫模型是最常用于药物经济学评价的模型。四项研究一致发现，在二甲双胍单药治疗未充分控制的 T2D 患者中，SGLT2i 比 GLP-1RA 更具成本效益。四项研究比较了 GLP-1RA 与 DPP-4i、磺酰脲类（SU）或胰岛素。除了一项表明 SU 具有成本效益外，其余均为 GLP-1RA。五项研究表明，SGLT2i 比 DPP-4i 或 SU 更具成本效益。十一项研究表明，DPP-4i 比传统抗糖尿病药物更具成本效益。四项额外的研究探讨了各种抗糖尿病药物作为二线选择的成本效益，表明 SU、SGLT2i 或米格列汀更具经济优势。最常见的驱动因素是新型抗糖尿病药物的成本。
结论
从成本效益角度来看，新型抗糖尿病药物作为二线治疗 T2D 是一种具有成本效益的选择，尤其是 SGLT2i。
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