在美国2型糖尿病患者中，与司美格鲁肽1毫克相比，替尔泊肽实现治疗目标的每位患者成本及需治疗人数。
Cost per Patient Achieving Treatment Targets and Number Needed to Treat with Tirzepatide Versus Semaglutide 1 mg in Patients with Type 2 Diabetes in the United States.
作者信息
Mody Reema R, Meyer Kellie L, Ward Jennifer M, O'Day Ken B
机构信息
Value, Evidence, and Outcomes, Eli Lilly and Company, Indianapolis, IN, USA.
Evidence Generation and Value Communications, AmerisourceBergen, Conshohocken, PA, USA.
出版信息
Diabetes Ther. 2023 Dec;14(12):2045-2055. doi: 10.1007/s13300-023-01470-w. Epub 2023 Sep 28.
INTRODUCTION
Achieving glycemic control can help reduce complications of type 2 diabetes (T2D). This study compared the pharmacy cost per responder and number needed to treat (NNT) of tirzepatide 5 mg, 10 mg, and 15 mg versus semaglutide 1 mg to achieve glycemic, weight loss, and composite treatment endpoints in patients with T2D in the United States.
METHODS
The proportions of patients achieving glycemic, weight loss, and composite treatment endpoints were obtained from the phase 3 SURPASS-2 randomized clinical trial which compared tirzepatide 5 mg, 10 mg, and 15 mg to semaglutide 1 mg. Annual pharmacy costs were calculated using 2022 wholesale acquisition costs. Cost per responder and NNT were calculated along with 95% confidence intervals and tests for statistical significance (P ≤ 0.05).
RESULTS
Tirzepatide had a lower cost per responder to achieve glycated hemoglobin A1c (HbA1c) endpoints of ≤ 6.5% (10 mg and 15 mg doses) and < 5.7% (all doses) and weight loss endpoints of ≥ 5% (10 mg and 15 mg doses), ≥ 10% (all doses), and ≥ 15% (all doses). The cost per responder to achieve HbA1c < 7% (all doses of tirzepatide) and ≤ 6.5% (5 mg tirzepatide) were not statistically significantly different between tirzepatide and semaglutide 1 mg. The cost per patient to achieve the composite endpoints (HbA1c < 7.0%, ≤ 6.5%, or < 5.7%/weight loss ≥ 10%/no hypoglycemia) was statistically significantly lower for all doses of tirzepatide than for semaglutide 1 mg. The NNTs for all doses of tirzepatide were statistically significantly lower than that for semaglutide 1 mg to achieve all individual and composite endpoints, with the exception of the 5 mg dose for HbA1c < 7.0% and HbA1c ≤ 6.5%, where tirzepatide had numerically lower NNTs that were not statistically significant.
CONCLUSION
Tirzepatide is a novel glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist (RA) that may offer the potential to achieve stringent glycemic goals, weight loss targets, and composite treatment goals at a lower cost per responder compared to semaglutide 1 mg among people with T2D.
引言
实现血糖控制有助于降低2型糖尿病（T2D）的并发症。本研究比较了5毫克、10毫克和15毫克替尔泊肽与1毫克司美格鲁肽在美国T2D患者中实现血糖、体重减轻和综合治疗终点的每位应答者的药房成本和需治疗人数（NNT）。
方法
实现血糖、体重减轻和综合治疗终点的患者比例来自3期SURPASS-2随机临床试验，该试验比较了5毫克、10毫克和15毫克替尔泊肽与1毫克司美格鲁肽。使用2022年批发采购成本计算年度药房成本。计算每位应答者的成本和NNT以及95%置信区间和统计学意义检验（P≤0.05）。
结果
替尔泊肽在实现糖化血红蛋白A1c（HbA1c）终点≤6.5%（10毫克和15毫克剂量）和<5.7%（所有剂量）以及体重减轻终点≥5%（10毫克和15毫克剂量）、≥10%（所有剂量）和≥15%（所有剂量）方面，每位应答者的成本较低。在实现HbA1c<7%（替尔泊肽所有剂量）和≤6.5%（5毫克替尔泊肽）方面替代肽与1毫克司美格鲁肽之间每位应答者的成本在统计学上无显著差异。所有剂量替尔泊肽实现综合终点（HbA1c<7.0%、≤6.5%或<5.7%/体重减轻≥10%/无低血糖）的每位患者成本在统计学上显著低于1毫克司美格鲁肽。除了HbA1c<7.0%和HbA1c≤6.5%的5毫克剂量外，替尔泊肽所有剂量的NNT在统计学上显著低于1毫克司美格鲁肽，以实现所有个体和综合终点，替尔泊肽的NNT在数值上较低，但无统计学意义。
结论
替尔泊肽是一种新型的葡萄糖依赖性促胰岛素多肽（GIP）和胰高血糖素样肽-1（GLP-1）受体激动剂（RA），与1毫克司美格鲁肽相比，它可能有潜力以更低的每位应答者成本实现严格的血糖目标、体重减轻目标和综合治疗目标。
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