治疗2型糖尿病的3种口服降糖药方案成本-效果分析

Cost-effectiveness analysis of 3 oral hypoglycemic agents therapeutic schemes in treatment for type 2 diabetes mellitus

目的评价治疗2型糖尿病的3种口服用药方案的疗效及费用情况。方法243例2型糖尿病病人,随机分为3组。A组,二甲双胍0.5g,tid+格列吡嗪5mg,qd;B组,二甲双胍0.5g,tid+瑞格列奈1mg,tid;C组二甲双胍0.5g,tid+阿卡波糖100mg,tid。疗程均为30d。治疗后进行成本-效果分析。结果A,B,C三组空腹血糖(FPG)和餐后2h血糖(2hPG)的成本-效果比(C/E)分别为2.13、3.20、6.29和2.32、2.93、5.93;B,C两组相对A组的增量成本-效果比(ΔC/ΔE)分别为-9.95,-142.01和9.37,35.37。敏感度分析结果与参数改变前的结果基本一致。3组不良反应率分别为6%、5%和6%,无显著差异(P>0.05)。结论3组疗效相当,二甲双胍联用格列吡嗪治疗2型糖尿病有较佳的成本-效果比。

AIM To evaluate the effectiveness and cost-effectiveness analysis of 3 oral hypoglycemic agents therapeutic schemes in treatment of type 2 diabetes mellitus. METHODS Two hundred and forty-three patients with type 2 diabetes mellitus were randomly divided into 3 groups： group A （metformin 0.5 g, tid ＋ glipizide 5 rag, qd）; group B （metformin 0.5 g, tid ＋ repaglinide 1 mg, tid; group C （metformin 0.5 g, tid ＋ acarbose 100 mg, tid） . Course of treatment was 30 d for each group. The outcomes of the 3 groups were evaluated by cost-effectiveness analysis after the treatment. RESULTS The fasting and postprandial plasma glucose （FPG and 2 h PG） cost-effectiveness （C/E） values of the 3 groups were respectively 2.13, 3.20, 6.29 and 2.32, 2.93, 5.93. The incremental cost-effectiveness （AC/AE） values of B, C groups were respectively -9.95, -142.01 and 9.37, 35.37 correlative with those in A group. The results of sensitivity analysis before and after change of parameters were basically the same. Adverse reaction rates of group A, B and C were 6% 5% and 5%, with no significant difference （P 〉 0.05）. CONCLUSION The total effective value and adverse reaction rates among-3 groups are nearly equivalent. Metformin combined with glipizide is the preferable scheme to the others.