中国2型糖尿病患者应用门冬胰岛素30与甘精胰岛素的成本-效果分析

吴晶, 贺小宁, 刘艳辉

中国药学杂志 ›› 2016, Vol. 51 ›› Issue (3) : 242-247.

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中国药学杂志 ›› 2016, Vol. 51 ›› Issue (3) : 242-247. DOI: 10.11669/cpj.2016.03.021
论 著

中国2型糖尿病患者应用门冬胰岛素30与甘精胰岛素的成本-效果分析

  • 吴晶1, 贺小宁1, 刘艳辉2
作者信息 +

Cost-Effectiveness Analysis of Insulin Aspart 30 Versus Insulin Glargine in Patients with Type 2 Diabetes in China

  • WU Jing1, HE Xiao-ning1, LIU Yan-hui2
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文章历史 +

摘要

目的 评价中国2型糖尿病患者使用每日1次门冬胰岛素30与甘精胰岛素的长期成本-效果。方法 采用公开发表且经过验证的IMS CORE糖尿病模型,模拟两组患者长期生存(30年)获得的生命年(LYs)、质量调整生命年(QALYs)和所花费的直接医疗成本,并进行成本-效果分析。患者的基线特征、治疗方案和临床效果数据来源于Easymix临床试验(临床试验注册号:NCT01123980)和其他文献。降糖治疗成本基于Easymix研究中国亚组的胰岛素和口服降糖药剂量以及发改委最高零售限价计算获得。糖尿病疾病管理成本和并发症成本来自2011年中国9个城市20家医院的调查数据,并利用居民消费价格指数(CPI)将其调整到2013年的水平。效用数据也来源于公开发表的文献。采用3%的年贴现率对成本和健康产出进行贴现。对贴现率、研究时限及降糖治疗成本等关键因素进行单因素敏感度分析,采用蒙特卡洛模拟进行概率敏感度分析。结果 门冬胰岛素30组患者与甘精胰岛素组患者相比,LYs增加了0.11年(13.72年 vs 13.60年),QALYs增加了0.10年(9.66年 vs 9.56年),总成本降低了46 809元(197 496元 vs 244 305元),是具有经济性的绝对优势方案。敏感度分析进一步验证了此结果的稳健性。结论 与使用甘精胰岛素相比,使用门冬胰岛素30可以获得更长的生命年和质量调整生命年,且直接医疗成本更低,是一种成本节约的治疗方案。

Abstract

OBJECTIVE To evaluate the long-term cost-effectiveness of once-daily biphasic insulin aspart (BIAsp 30) versus insulin glargine (IGlarg) in patients with type 2 diabetes (T2DM) in China. METHODS The validated and peer-reviewed CORE Diabetes Model was employed to simulate disease progression and determine the total direct medical cost, life years (LYs) and quality-adjusted life years (QALYs) over 30 years. Simulated cohorts and treatment effects were based on the Chinese subgroup (n=422) in the Easymix study (identifier in ClinicalTrials.gov: NCT01123980) which was an open-label, randomized, two-arm and multicenter trial among insulin-nave people with T2DM. Treatment costs were based on insulin doses in the trial and market retail prices in China. Management and complication costs were obtained from Chinese published data in 2011 and adjusted to the price level of 2013 with consumer price index. An annual discounting rate of 3% was used for both costs and health outcomes. One-way sensitivity analyses and probability sensitivity analyses were performed. RESULTS Treatment with BIAsp 30 is associated with LY gain of 0.11 (13.72 vs 13.60) and QALY gain of 0.10(9.66 vs 9.56) compared with IGlarg over 30 years. In terms of total average cost per patient, BIAsp 30 was less costly than IGlarg (CNY-46 809, CNY 197 496 vs 244 305). Sensitivity analyses demonstrated robustness of the results. CONCLUSION Compared with once daily IGlarg, treatment with BIAsp 30 is projected to be associated with improved life expectancy and reduces direct medical cost, represents a dominant treatment option among patients with T2DM.

关键词

2型糖尿病 / 门冬胰岛素30 / 甘精胰岛素 / 成本-效果 / 质量调整生命年

Key words

type 2 diabetes / insulin aspart 30 / insulin glargine / cost-effectiveness / QALYs

引用本文

导出引用
吴晶, 贺小宁, 刘艳辉. 中国2型糖尿病患者应用门冬胰岛素30与甘精胰岛素的成本-效果分析[J]. 中国药学杂志, 2016, 51(3): 242-247 https://doi.org/10.11669/cpj.2016.03.021
WU Jing, HE Xiao-ning, LIU Yan-hui. Cost-Effectiveness Analysis of Insulin Aspart 30 Versus Insulin Glargine in Patients with Type 2 Diabetes in China[J]. Chinese Pharmaceutical Journal, 2016, 51(3): 242-247 https://doi.org/10.11669/cpj.2016.03.021
中图分类号: R956   

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