维格列汀与二甲双胍合用治疗糖尿病的药物经济学研究

Economic Evaluation of Vildagliptin as Add-on Therapy to Metformin in Diabetes Mellitus Treatment in China

目的比较维格列汀、吡格列酮、格列美脲分别与二甲双胍合用治疗2型糖尿病时的效果、成本及成本-效果。方法运用Markov模型对三种治疗方案的终身治疗成本及效用(期望寿命、质量调整寿命年)进行经济学评价,通过文献资料和专家问卷咨询获得临床、生命质量、并发症年治疗成本等数据,进行敏感度分析。结果维格列汀、吡格列酮、格列美脲分别与二甲双胍合用治疗2型糖尿病分别延长11.02、10.96、10.90个质量调整生命年,而生命周期中三种治疗方案的治疗费用分别为124892元、134135元、126010元。敏感度分析证明了结果的可靠性。结论与吡格列酮、格列美脲合并二甲双胍质量相比,维格列汀合并二甲双胍治疗获得的健康效果更好,而治疗成本更低。

Objective The objective of the study was to evaluate the cost-effectiveness of vildagliptin compared to pioglitazone and glimepidde when added on to metformin in the treatment of type 2 diabetes meUitus in China. Methods A Markov model was designed to evaluate the lifetime costs and outcomes （life expectancy and QALYs gained） of three different therapies of diabetes mellitus from health insurance perspective. Based on UKPDS Outcomes Model, the model included the following risk engine to simulate complications, including ischemic heart disease, fatal and non-fatal myocardial infarction, heart failure, stroke, blindness, renal failure, amputation, diabetes-related mortality and other deaths. The clinical and quality of life data were obtained from published literature and re-confirmed based on a questionnaire survey from a clinical expert panel of 20 diabetes specialists. The annual cost was calculated based on expert opinions. A probabilistic sensitivity analysis was performed to understand the key drivers and general sensitivity of the model. Results The treatment of metformin＋vildagliptin, mefformin＋ piogiitazone and metformin＋glimepiride therapy can prolong the average 11.02, 10.96 and 10.90 QALYs per patient. The lifetime cost per patient treated with vildagliptin, pioglitazone and glimepidde added-on to metformin was CNY 124892, CNY 134135 and CNY 126010, respectively. Sensitivity analyses proved the robustness of the result. Conclusion Compared to metformin＋pioglitazone and metformin＋glimepiride therapies, vildagliptin＋metformin therapy improves health outcomes and also leads to cost saving in the treatment of diabetes mellitus in China.