Hu Ying, Zou Huimin, Shen Yang, Ni Qi, Li Yijun, Zhang Hao, Chen Xianwen, Ung Carolina Oi Lam, Hu Hao, Mu Yiming
Department of Endocrinology, First Medical Center of Chinese, PLA General Hospital, Beijing, China.
State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao.
Diabetes Ther. 2025 May;16(5):915-929. doi: 10.1007/s13300-025-01716-9. Epub 2025 Mar 19.
This study aimed to evaluate the long- and short-term cost-effectiveness of once-weekly semaglutide versus dulaglutide for treating patients with type 2 diabetes uncontrolled with metformin after the renewal of China's national reimbursement drug list.
This analysis was conducted using the Institute of Health Economics Diabetes Cohort Model (IHE-DCM) to evaluate the long-term health and economic outcomes of semaglutide 0.5 mg, 1.0 mg, and dulaglutide 1.5 mg. It was performed from the perspective of the Chinese healthcare systems over a 40-year time horizon, with an annual discount rate of 5%. Baseline cohort characteristics and treatment effects were sourced from the head-to-head clinical trial SUSTAIN 7, which compared the efficacy and safety of semaglutide and dulaglutide. The analysis included direct medical costs regarding antidiabetic treatment and complication treatment. The long-term cost-effectiveness analysis used quality-adjusted life years (QALYs) as the primary health outcome. The robustness of the results was evaluated through one-way sensitivity analyses and probabilistic sensitivity analyses. The short-term cost-effectiveness analysis, focusing on the proportion of patients achieving clinical targets as the health outcome, compared the control costs of successfully treating a patient to meet clinical treatment goals between semaglutide 0.5 mg, 1.0 mg, and dulaglutide 1.5 mg over a 40-week study period.
Compared with dulaglutide 1.5 mg, once-weekly semaglutide 0.5 mg demonstrated an improvement of 0.08 QALYs and a reduction in total direct medical costs of 5476 Chinese yuan (CNY); Once-weekly semaglutide 1.0 mg showed an increase of 0.19 QALYs, and a decrease in total direct medical costs of 6711 CNY. Sensitivity analyses confirmed the robustness of these results. In the short-term cost-of-control study, once-weekly semaglutide 0.5 mg demonstrated lower treatment costs for all targets: the costs of control for dulaglutide 1.5 mg were 1.2-2.1 times as much as that of semaglutide 0.5 mg once weekly. Semaglutide 1.0 mg achieved similar treatment costs for the good glycemic control goal (HbA < 7%) to dulaglutide 1.5 mg. However, when looking at tight glycemic control, weight management targets, and composite targets relating to weight loss, once-weekly semaglutide 1.0 mg showed lower treatment costs compared to dulaglutide 1.5 mg to bring at least one patient to achieve these targets.
Compared to dulaglutide 1.5 mg, once-weekly semaglutide remains cost-effective for treating type 2 diabetes uncontrolled on metformin in China under the new negotiation price. However, limitations exist, including the reliance on SUSTAIN-7 data and the lack of specific utility data for the Chinese population.
本研究旨在评估在中国国家医保药品目录更新后，每周一次的司美格鲁肽与度拉糖肽治疗二甲双胍治疗效果不佳的2型糖尿病患者的长期和短期成本效益。
本分析采用卫生经济研究所糖尿病队列模型（IHE-DCM）来评估0.5毫克、1.0毫克司美格鲁肽和1.5毫克度拉糖肽的长期健康和经济结果。该分析是从中国医疗体系的角度，在40年的时间范围内进行的，年贴现率为5%。基线队列特征和治疗效果来自头对头临床试验SUSTAIN 7，该试验比较了司美格鲁肽和度拉糖肽的疗效和安全性。分析包括抗糖尿病治疗和并发症治疗的直接医疗成本。长期成本效益分析使用质量调整生命年（QALY）作为主要健康结果。通过单向敏感性分析和概率敏感性分析评估结果的稳健性。短期成本效益分析以达到临床目标的患者比例作为健康结果，比较了在40周的研究期内，0.5毫克、1.0毫克司美格鲁肽和1.5毫克度拉糖肽成功治疗一名患者以达到临床治疗目标的对照成本。
与1.5毫克度拉糖肽相比，每周一次的0.5毫克司美格鲁肽显示质量调整生命年提高了0.08，直接医疗总成本降低了5476元人民币（CNY）；每周一次的1.0毫克司美格鲁肽显示质量调整生命年增加了0.19，直接医疗总成本降低了6711元人民币。敏感性分析证实了这些结果的稳健性。在短期控制成本研究中，每周一次的0.5毫克司美格鲁肽在所有目标上的治疗成本更低：1.5毫克度拉糖肽的控制成本是每周一次0.5毫克司美格鲁肽的1.2至2.1倍。对于良好血糖控制目标（糖化血红蛋白<7%），1.0毫克司美格鲁肽的治疗成本与1.5毫克度拉糖肽相似。然而，在严格血糖控制、体重管理目标以及与体重减轻相关的复合目标方面，每周一次的1.0毫克司美格鲁肽与1.5毫克度拉糖肽相比，使至少一名患者达到这些目标的治疗成本更低。
与1.5毫克度拉糖肽相比，在新谈判价格下，每周一次的司美格鲁肽在中国治疗二甲双胍控制不佳的2型糖尿病方面仍具有成本效益。然而，存在局限性，包括对SUSTAIN-7数据的依赖以及缺乏针对中国人群的特定效用数据。
