Gu Shuyan, Gu Jinghong, Wang Xiaoyong, Wang Xiaoling, Li Lu, Gu Hai, Xu Biao
Center for Health Policy and Management Studies, School of Government, Nanjing University, 163 Xianlin Road, Nanjing, 210023, Jiangsu, China.
Department of Economics, University of Washington, Seattle, WA, USA.
Health Econ Rev. 2024 Apr 2;14(1):26. doi: 10.1186/s13561-024-00499-2.
To estimate the long-term cost-effectiveness of once-weekly semaglutide versus sitagliptin as an add-on therapy for type 2 diabetes patients inadequately controlled on metformin in China, to better inform healthcare decision making.
The Cardiff diabetes model which is a Monte Carlo micro-simulation model was used to project short-term effects of once-weekly semaglutide versus sitagliptin into long-term outcomes. Short-term data of patient profiles and treatment effects were derived from the 30-week SUSTAIN China trial, in which 868 type 2 diabetes patients with a mean age of 53.1 years inadequately controlled on metformin were randomized to receive once-weekly semaglutide 0.5 mg, once-weekly semaglutide 1 mg, or sitagliptin 100 mg. Costs and quality-adjusted life years (QALYs) were estimated from a healthcare system perspective at a discount rate of 5%. Univariate sensitivity analysis, scenario analysis, and probabilistic sensitivity analysis were conducted to test the uncertainty.
Over patients' lifetime projections, patients in both once-weekly semaglutide 0.5 mg and 1 mg arms predicted less incidences of most vascular complications, mortality, and hypoglycemia, and lower total costs compared with those in sitagliptin arm. For an individual patient, compared with sitagliptin, once-weekly semaglutide 0.5 mg conferred a small QALY improvement of 0.08 and a lower cost of $5173, while once-weekly semaglutide 1 mg generated an incremental QALY benefit of 0.12 and a lower cost of $7142, as an add-on to metformin. Therefore, both doses of once-weekly semaglutide were considered dominant versus sitagliptin with more QALY benefits at lower costs.
Once-weekly semaglutide may represent a cost-effective add-on therapy alternative to sitagliptin for type 2 diabetes patients inadequately controlled on metformin in China.
评估在中国，对于二甲双胍治疗血糖控制不佳的2型糖尿病患者，每周一次注射司美格鲁肽与西格列汀作为附加治疗的长期成本效益，以更好地为医疗决策提供依据。
采用卡迪夫糖尿病模型（一种蒙特卡洛微观模拟模型）将每周一次注射司美格鲁肽与西格列汀的短期效果预测为长期结果。患者资料和治疗效果的短期数据来自为期30周的中国司美格鲁肽疗效和安全性研究（SUSTAIN China）试验，该试验将868例平均年龄53.1岁、二甲双胍治疗血糖控制不佳的2型糖尿病患者随机分为三组，分别接受每周一次注射0.5毫克司美格鲁肽、每周一次注射1毫克司美格鲁肽或100毫克西格列汀治疗。从医疗保健系统角度，以5%的贴现率估算成本和质量调整生命年（QALY）。进行单因素敏感性分析、情景分析和概率敏感性分析以检验不确定性。
在患者的终身预测中，与西格列汀组相比，每周一次注射0.5毫克司美格鲁肽组和每周一次注射1毫克司美格鲁肽组预测的大多数血管并发症、死亡率和低血糖发生率更低，总成本也更低。对于个体患者，作为二甲双胍的附加治疗，与西格列汀相比，每周一次注射0.5毫克司美格鲁肽使QALY小幅改善0.08，成本降低5173美元，而每周一次注射1毫克司美格鲁肽产生的增量QALY效益为0.12，成本降低7142美元。因此，两种剂量的每周一次注射司美格鲁肽均被认为优于西格列汀，以更低成本获得更多QALY效益。
对于中国二甲双胍治疗血糖控制不佳的2型糖尿病患者，每周一次注射司美格鲁肽可能是一种具有成本效益的替代西格列汀的附加治疗方案。
