共同照护全病程规范化管理2型糖尿病患者的成本-效果分析

Cost-effectiveness analysis of standardization management of patients with type 2 diabetes mellitus under the diabetes shared care model during the holonomic disease process

目的评价在共同照护面对面+远程全病程规范化管理模式下T2DM患者的管理成本效益情况,采用CORE模型评价北京大学第一医院的糖尿病共同照护模式,对管理T2DM患者长期经济与健康效果。方法选取2016年10月至2021年12月于北京大学第一医院糖尿病共同照护模式下,随访≥1年的T2DM患者1835例作为共同照护组,另选取2019年5月至2021年12月于北京大学第一医院,普通随访≥1年的T2DM患者126例作为普通随访组。采用CORE模型(IQVIA CORE Diabetes model 9.0),基于中国T2DM患者公开临床数据,模拟两组管理模式下T2DM患者30年治疗总成本、期望寿命和质量调整生命年(QALY)。成本以直接医疗成本计算,包括降糖药物、管理人员和DM并发症的成本。直接医疗成本和效用均采用5%贴现率。采用单因素敏感性分析评估研究结果的稳定性。结果与普通随访组比较,共同照护组30年治疗成本增加22431.50(261946.98±5110.22vs 239515.48±5381.53)元,期望寿命增加0.104(12.698±0.108 vs 12.595±0.113)年,QALY增加0.099(9.105±0.081 vs 9.005±0.085),增量成本效果比值为225669.00(95%CI 205290.00~248880.00)元/QALY。敏感性分析结果和可接受曲线图进一步验证了结果的稳健性。结论相比于传统模式,共同照护采用面对面+远程全病程规范化管理模式可显著提高T2DM患者的期望寿命,是一项具有成本效益比的管理模式。

Objective To evaluate the cost-effectiveness of in-person and remote standardization management of patients with type 2 diabetes mellitus(T2DM)receiving diabetes shared care,to evaluate the long-term economic and health outcomes of diabetes shared care model at Peking University First Hospital in the management of T2DM patients using CORE economics model.Methods From October 2016 to December 2021,1835 patients with T2DM who were followed up for more than one year in the diabetes shared care model of Peking University First Hospital were selected as the shared care group,and 126 patients with T2DM who were followed up for more than one year in Peking University First Hospital from May 2019to December 2021 were selected as the general follow-up group.Based on the open clinical data of T2DM patients in China,the IQVIA CORE Diabetes Model 9.0 was employed to simulate the total cost of diabetes treatment,life expectancy and quality-adjusted life years(QALY)under two management models for 30years.Costs in this study were calculated as direct medical costs and included the costs of glucose-lowering medications,administrative staff,and diabetes complications.Direct medical costs and utility were discounted at a 5%rate.Univariate sensitivity analysis was used to evaluate the stability of the study results.Results The shared care group was associated with cost gain of 22431.50(261946.98±5110.22 vs 239515.48±5381.53)yuan,life expectancy gain of 0.104(12.698±0.108 vs 12.595±0.113)years and QALY gain of0.099(9.105±0.081 vs 9.005±0.085)compared with the general follow-up group.Sensitivity analyses and acceptability curve demonstrated robustness of the results.Conclusion Compared with the conventional model,the diabetes shared care in-person and remote standardized management during the holonomic disease process can significantly improve the life expectancy of T2DM patients,which is a cost effective management model.