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5种GLP-1RAs治疗二甲双胍控制不佳的2型糖尿病的成本-效用分析
Cost-utility analysis of 5 kinds of GLP-1RAs in the treatment of poorly controlled type 2 diabetes mellitus treated with metformin
- 中国药房 2024年35卷第6期 页码：718-723
- 作者机构：
广东药科大学附属第一医院临床药学重点专科，广州 510030
- 作者简介：
药师，硕士研究生。研究方向：临床药学、药物经济学。E-mail：578365488@qq.com
主任药师，硕士生导师。研究方向：临床药学、药事管理。E-mail：cjslym@163.com
- 基金信息：基金项目中央财政医疗服务与保障能力提升资金(No.Z155080000004)
DOI：10.6039/j.issn.1001-0408.2024.06.14
中图分类号： R956纸质出版日期：2024-03-30，
收稿日期：2023-11-09，
修回日期：2024-03-04，
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谢泽宇,李梦婷,胡佳等.5种GLP-1RAs治疗二甲双胍控制不佳的2型糖尿病的成本-效用分析 Δ[J].中国药房,2024,35(06):718-723.
XIE Zeyu,LI Mengting,HU Jia,et al.Cost-utility analysis of 5 kinds of GLP-1RAs in the treatment of poorly controlled type 2 diabetes mellitus treated with metformin[J].ZHONGGUO YAOFANG,2024,35(06):718-723.
谢泽宇,李梦婷,胡佳等.5种GLP-1RAs治疗二甲双胍控制不佳的2型糖尿病的成本-效用分析 Δ[J].中国药房,2024,35(06):718-723. DOI： 10.6039/j.issn.1001-0408.2024.06.14.
XIE Zeyu,LI Mengting,HU Jia,et al.Cost-utility analysis of 5 kinds of GLP-1RAs in the treatment of poorly controlled type 2 diabetes mellitus treated with metformin[J].ZHONGGUO YAOFANG,2024,35(06):718-723. DOI： 10.6039/j.issn.1001-0408.2024.06.14.
摘要
目的
2
评估5种胰高血糖素样肽-1受体激动剂（GLP-1RAs）治疗二甲双胍控制血糖不佳的2型糖尿病（T2DM）的长期经济性。
方法
2
提取既往发表的荟萃分析及其纳入的随机对照研究（RCT）中患者的基线数据，使用英国前瞻性糖尿病研究结果模型2.1预测各组患者的生存情况、长期疗效和成本，采用成本-效用分析法比较5种GLP-1RAs（利拉鲁肽、利司那肽、艾塞那肽、度拉糖肽和司美格鲁肽）的经济性；采用敏感性分析和情境分析验证基础分析结果的稳定性。
结果
2
共纳入21项RCT，6 796名患者。生存曲线表明，司美格鲁肽在降低因心血管疾病死亡风险上、度拉糖肽在降低全因死亡风险上较其他GLP-1RAs具有优势。成本-效用分析结果显示，5种方案的经济性从优到劣排序依次为利司那肽、司美格鲁肽、艾塞那肽、度拉糖肽和利拉鲁肽。单因素敏感性分析和概率敏感性分析表明基础分析结果稳健。情境分析结果显示，司美格鲁肽的价格至少降低54.64%，降至369.21元，其对比利司那肽才具有经济性。
结论
2
对于使用二甲双胍治疗后血糖控制不佳的我国T2DM患者，临床可考虑优先选择利司那肽和司美格鲁肽。
Abstract
OBJECTIVE
2
To assess the long-term cost-effectiveness of five glucagon-like peptide-1 receptor agonists （GLP-1RAs） in the treatment of poorly controlled type 2 diabetes mellitus （T2DM） treated with metformin.
METHODS
2
Baseline data from patients in previously published meta-analysis and included randomized controlled trials （RCTs） were extracted to predict survival， long-term efficacy， and costs for each group using the United Kingdom prospective diabetes study outcome model 2.1. The cost-effectiveness of 5 GLP-1RAs （liraglutide， lixisenatide， exenatide， dulaglutide， and semaglutide） was analyzed by cost-utility analysis. Sensitivity analysis and scenario analysis were also performed to verify the uncertainty of basic analysis results.
RESULTS
2
A total of 21 RCTs with 6 796 patients were included. Survival analysis curves showed the superiority of semaglutide in reducing the risk of death from cardiovascular disease and dulaglutide in reducing the risk of all-cause mortality over other GLP-1RAs. The cost-utility analysis showed that the five drugs were economically superior to inferior in the order of lixisenatide， semaglutide， exenatide， dulaglutide， and liraglutide； one-way and probabilistic sensitivity analyses indicated that the results were robust. The scenario analysis results indicated that the price of semaglutide should decrease by at least 54.64% to 369.21 yuan， which is cost-effectiveness compared to lixisenatide.
CONCLUSIONS
2
For T2DM patients in China with poor glycemic control after treatment with metformin， lixisenatide and semaglutide may be considered as the preferred regimen.
关键词
胰高血糖素样肽-1受体激动剂利司那肽司美格鲁肽艾塞那肽度拉糖肽利拉鲁肽成本-效用分析2型糖尿病
Keywords
lixisenatidesemaglutideexenatidedulaglutideliraglutidecost-utility analysistype 2 diabetes mellitus
references
American Diabetes Association. Economic costs of diabetes in the U.S. in 2017[J]. Diabetes Care，2018，41（5）：917-928.
WANG L，PENG W，ZHAO Z，et al. Prevalence and treatment of diabetes in China，2013-2018[J]. JAMA，2021，326（24）：2498-2506.
LIU J L，LIU M，CHAI Z L，et al. Projected rapid growth in diabetes disease burden and economic burden in China：a spatio-temporal study from 2020 to 2030[J]. Lancet Reg Health West Pac，2023，33：100700.
《中国老年型糖尿病防治临床指南》编写组. 中国老年2型糖尿病防治临床指南：2022年版[J]. 中国糖尿病杂志，2022，30（1）：2-51.
Writing Group of Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly in China. Clinical guidelines for the prevention and treatment of type 2 diabetes in the elderly in China：2022 edition[J]. Chin J Diabetes，2022，30（1）：2-51.
WANG L M，GAO P，ZHANG M，et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J]. JAMA，2017，317（24）：2515-2523.
ALI M K，BULLARD K M，SAYDAH S，et al. Cardiovascular and renal burdens of prediabetes in the USA：analysis of data from serial cross-sectional surveys，1988-2014[J]. Lancet Diabetes Endocrinol，2018，6（5）：392-403.
PAN Y S，CHEN W Q，WANG Y J. Prediabetes and outcome of ischemic stroke or transient ischemic attack：a systematic review and meta-analysis[J]. J Stroke Cerebrovasc Dis，2019，28（3）：683-692.
HUANG Y L，CAI X Y，MAI W Y，et al. Association between prediabetes and risk of cardiovascular disease and all cause mortality：systematic review and meta-analysis[J]. BMJ，2016，355：i5953.
MOSENZON O，ALGUWAIHES A，LEON J L A，et al. CAPTURE：a multinational，cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries[J]. Cardiovasc Diabetol，2021，20（1）：154.
中华医学会糖尿病学分会. 中国2型糖尿病防治指南：2020年版[J]. 国际内分泌代谢杂志，2021，41（5）：482-548.
Chinese Medical Association，Diabetes Branch.Guideline for the prevention and treatment of type 2 diabetes mellitus in China：2020 edition[J]. Int J Endocrinol Metab，2021，41（5）：482-548.
American Diabetes Association. Introduction：standards of medical care in diabetes：2022[J]. Diabetes Care，2022，45（Suppl 1）：S1-S2.
XIE Z Y，HU J，GU H Y，et al. Comparison of the efficacy and safety of 10 glucagon-like peptide-1 receptor agonists as add-on to metformin in patients with type 2 diabetes：a systematic review[J]. Front Endocrinol，2023，14：1244432.
HAYES A J，LEAL J，GRAY A M，et al. UKPDS outcomes model 2：a new version of a model to simulate lifetime health outcomes of patients with type 2 diabetes mellitus using data from the 30-year United Kingdom Prospective Diabetes Study：UKPDS 82[J]. Diabetologia，2013，56（9）：1925-1933.
World Health Organization. The world health report 2002[J]. Midwifery，2003，19（1）：72-73.
GAO L，ZHAO F L，LI S C. Cost-utility analysis of liraglutide versus glimepiride as add-on to metformin in type 2 diabetes patients in China[J]. Int J Technol Assess Health Care，2012，28（4）：436-444.
BERTRAM M Y，LAUER J A，DE JONCHEERE K，et al. Cost-effectiveness thresholds：pros and cons[J]. Bull World Health Organ，2016，94（12）：925-930.
LI X，XU Z R，JI L N，et al. Direct medical costs for patients with type 2 diabetes in 16 tertiary hospitals in urban China：a multicenter prospective cohort study[J]. J Diabetes Investig，2019，10（2）：539-551.
SU W，LI C Y，ZHANG L，et al. Meta-analysis and cost-effectiveness analysis of insulin glargine 100 U/mL versus insulin degludec for the treatment of type 2 diabetes in China[J]. Diabetes Ther，2019，10（5）：1969-1984.
DENG J，GU S Y，SHAO H，et al. Cost-effectiveness analysis of exenatide twice daily（bid）vs insulin glargine once daily（qd）as add-on therapy in Chinese patients with type 2 diabetes mellitus inadequately controlled by oral therapies[J]. J Med Econ，2015，18（11）：974-989.
CAI X L，SHI L Z，YANG W J，et al. Cost-effectiveness analysis of dapagliflozin treatment versus metformin treatment in Chinese population with type 2 diabetes[J]. J Med Econ，2019，22（4）：336-343.
HOU X Y，WAN X，WU B. Cost-effectiveness of canagliflozin versus dapagliflozin added to metformin in patients with type 2 diabetes in China[J]. Front Pharmacol，2019，10：480.
WU B，WAN X，MA J. Cost-effectiveness of prevention and management of diabetic foot ulcer and amputation in a health resource-limited setting[J]. J Diabetes，2018，10（4）：320-327.
PAN C W，SUN H P，ZHOU H J，et al. Valuing health-related quality of life in type 2 diabetes patients in China[J]. Med Decis Making，2016，36（2）：234-241.
CURRIE C J，MCEWAN P，PETERS J R，et al. The routine collation of health outcomes data from hospital treated subjects in the Health Outcomes Data Repository（HODaR）：descriptive analysis from the first 20 000 subjects[J]. Value Health，2005，8（5）：581-590.
CLARKE P，GRAY A，HOLMAN R. Estimating utility values for health states of type 2 diabetic patients using the EQ-5D（UKPDS 62）[J]. Med Decis Making，2002，22（4）：340-349.
姚嘉奇，管欣，张瑶，等. 药物经济学概率敏感性分析中关联参数的处理与实践探讨[J]. 中国药物评价，2019，36（2）：150-155.
YAO J Q，GUAN X，ZHANG Y，et al. Discussion and practice of correlating parameters in sensitivity analysis of pharmacoeconomics[J]. Chin J Drug Eval，2019，36（2）：150-155.
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