钠-葡萄糖协同转运蛋白2抑制剂用于2型糖尿病的经济价值异质性：亚组建模成本效益分析

Heterogeneity in Economic Value of SGLT2is for Type 2 Diabetes: Subgroup Modeling Cost-Effectiveness Analyses.

作者信息

Chong Kah Suan, Yang Chun-Ting, Wang Chi-Chuan, Ou Huang-Tz, Kuo Shihchen

机构信息

Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan.

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

出版信息

Pharmacoeconomics. 2025 Sep 12. doi: 10.1007/s40273-025-01536-6.

DOI:10.1007/s40273-025-01536-6

PMID:40940626

Abstract

BACKGROUND AND OBJECTIVE

Although heterogeneous treatment effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) have been revealed, the heterogeneous economic value of SGLT2is in real-world type 2 diabetes (T2D) populations with diverse clinical characteristics remains unclear. We conducted subgroup cost-effectiveness analyses of SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP4is) among patients with T2D.

METHODS

A multi-state transition model was used to estimate the incremental cost-effectiveness ratios (ICERs, in US$ per quality-adjusted life-years [QALYs] gained) and value-based pricing (VBP) among patients with T2D stratified by age, estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), and body mass index (BMI) over 5 years and a Lifetime horizon from a healthcare sector perspective, with both costs and quality-adjusted Life years discounted at 3% annually. Model inputs included treatment effects derived from analysis of individual-level data in Taiwan, and health utilities and costs sourced from published Literature of Taiwanese populations. Deterministic and probabilistic sensitivity analyses across subgroups were performed. All costs were standardized to 2022.

RESULTS

Over 5 years, the ICERs of SGLT2is versus DPP4is were as follows: age subgroups (< 65 versus ≥ 65 years: $26,520 versus $2298/QALY-gained), eGFR subgroups (60 ~ < 90 versus ≥ 90 ml/min/1.73 m: $7700 versus $12,884/QALY-gained), HbA1c subgroups (< 8.5 versus ≥ 8.5%: $7001 versus $9488/QALY-gained), and BMI subgroups (< 30 versus ≥ 30 kg/m: $7266 versus $9714/QALY-gained). Over a lifetime, the ICERs became lower, ranging from $2369/QALY-gained for those aged ≥ 65 years to $4239/QALY-gained for those aged < 65 years. Over 5 years, the annual VBP of SGLT2is ranged from $310 for those aged < 65 years to $1267 for those aged ≥ 65 years.

CONCLUSIONS

Our analysis suggests that adopting SGLT2is over DPP4is for T2D is highly cost-effective across patient subgroups, particularly for the elderly and patients with mild renal impairment.

摘要

背景与目的

尽管已揭示了钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）的异质性治疗效果，但SGLT2i在具有不同临床特征的真实世界2型糖尿病（T2D）人群中的异质性经济价值仍不明确。我们对T2D患者中SGLT2i与二肽基肽酶4抑制剂（DPP4i）进行了亚组成本效益分析。

方法

采用多状态转换模型，从医疗保健部门的角度，估计按年龄、估计肾小球滤过率（eGFR）、糖化血红蛋白（HbA1c）和体重指数（BMI）分层的T2D患者在5年和终身期间的增量成本效益比（ICER，以每获得的质量调整生命年[QALY]的美元数计）和基于价值的定价（VBP），成本和质量调整生命年均按每年3%进行贴现。模型输入包括从台湾个体水平数据分析得出的治疗效果，以及从台湾人群的已发表文献中获取的健康效用和成本。对各亚组进行了确定性和概率敏感性分析。所有成本均标准化为2022年的水平。

结果

在5年期间，SGLT2i与DPP4i的ICER如下：年龄亚组（<65岁与≥65岁：每获得一个QALY分别为26,520美元与2298美元），eGFR亚组（60~<90与≥90 ml/min/1.73 m²：每获得一个QALY分别为7700美元与12,884美元），HbA1c亚组（<8.5%与≥8.5%：每获得一个QALY分别为7001美元与9488美元），以及BMI亚组（<30与≥30 kg/m²：每获得一个QALY分别为7266美元与9714美元）。在终身期间，ICER降低，范围从≥65岁者每获得一个QALY为2369美元到<65岁者每获得一个QALY为4239美元。在5年期间，SGLT2i的年度VBP范围从<65岁者的310美元到≥65岁者的1267美元。