胰岛素类似物与人胰岛素治疗糖尿病的药物经济学评价

Pharmacoeconomics Evaluation of Insulin Analogs versus Human Insulin for Diabetes:A Systematic Review

目的:对胰岛素类似物与人胰岛素的药物经济学评价进行综述,以期为相关决策提供依据。方法:通过中文及英文数据库检索胰岛素类似物与人胰岛素药物经济学评价相关文献,对各项经济学评价研究的基本情况、数据及结果进行综述。结果:共纳入16篇27项在加拿大、美国、欧洲各国、澳大利亚及中国开展的研究。各项研究的结果差异较大,主要原因可能是各项研究所采用的数据、模型、研究时限以及相关研究假设不同。加拿大、英国、德国和澳大利亚的公立机构对胰岛素类似物治疗糖尿病的经济性持谨慎怀疑态度,尤其不支持胰岛素类似物治疗2型糖尿病的经济性。结论:目前国际上还没有达成对胰岛素类似物治疗糖尿病经济性的统一认识。各发达国家在制订医保报销政策时对胰岛素类似物的推荐也采取了更加谨慎的态度。因此,我国也应根据国情、个人的疾病情况以及经济能力选择更加适合的药品。

OBJECTIVE： To systematically review the pharmacoeconomics of insulin analogs versus human insulin [NPH] so as to provide evidence for relevant health decision-making and clinical treatment. METHODS： Literatures about the pharmacoeconomics evaluation of insulin analogs versus human insulin were retrieved from Chinese and English literature database. Basic infor marion, data sources and results of included studies were analyzed and reviewed. RESULTS： 27 studies in 16 published papers carried out in Canada, USA, European, Australia and China were included in the review. The results of studies were significantly inconsistent, which was perhaps mainly due to the different data source, model selection, time horizon and hypothesis. However, the public health institutes in Canada, UK, Germany and Australia had reported highly suspiciousness on the economics of insulin analogs for diabetes patients, especially for type Ⅱ diabetes. CONCLUSIONS： In lack of powerful evidence, it has not reached an agreement about the economics of insulin analogs for diabetes. It can not be decided that the economics of insulin analogs is better than human insulin based on present studies. In developed countries, insulin analogs are recommended with caution in reimbursement policies. As China is a developing country, diabetes patients should select appropriate regimes even more cautiously according to local healthcare system, personal disease characteristics and affordability. More high-quality studies about economic evaluation of insulin analogs and human insulin on the basis of national condition are required to provide evidence for the government to allocate medical resources.