3种2型糖尿病治疗方案的成本-效果分析

Cost-effectiveness analysis of three therapeutic schemes for type 2 diabetes mellitus

目的用成本和效果方法比较2型糖尿病(T2DM)的3种治疗方案。方法运用药物经济学的基本思想对3种(口服药,口服药+1次胰岛素,口服药+2次胰岛素)T2DM的治疗方案进行成本-效果分析。结果 3种治疗方案的药物成本均数分别为827.30、1 714.50、1 087.50元(P=0.00);控制空腹血糖的有效率分别为56.51%、51.69%和57.04%(P=0.754);控制餐后2h血糖有效率分别为50.56%、40.68%和55.63%(P=0.097);3种治疗方案的空腹血糖成本效果比(C/E)分别为14.64、33.17和19.06,餐后2h血糖C/E分别为16.36、42.15和19.55;以口服药为参考,口服降糖药+注射1次胰岛素控制空腹血糖的增量成本比和控制餐后2h血糖的增量成本比分别为-184.4和-89.80,口服药+注射2次胰岛素的控制空腹血糖的增量成本比和控制餐后2h血糖的增量成本比分别为484.8和51.26。结论根据药物经济学原理,本研究分析的3种T2DM治疗方案中,效价比最优的是口服药物治疗组,而疗效较好的则是口服药+2次胰岛素治疗组。

Objective To compare and analyze of three therapeutic schemes for type 2 diabetes mellitus（T2DM） using the cost effectiveness. Methods Using the basic idea of pharmacoeconomics evaluate cost effect analysis method for three therapeutic schemes（oral glucose-lowering drugs, oral glucose-lowering drugs ＋ insulin injection one time,oral glucose-lowering drugs ＋ insu lin injection twice）. Results The three therapeutic schemes average cost of arrived to 827. 30 yuan/3 months, 1 714. 50 yuan/3 months and 1 087.50 yuan/3 months, respectively（P= 0.00） ;the efficiency of control fasting blood glucose were 56.51%, 51.69 and 57.04 %, respectively（P=0. 754） ;the efficiency of control 2 h postprandial blood glucose were 50.56 %, 40.68 % and 55.63%, respectively（P = 0.097） ; the cost-effectiveness ratio of fasting blood glucose were 14.64,33.17 and 19.06, respectively; the cost-ef- fectiveness ratio of 2 h postprandial blood sugar were 16.36,42. 15 and 19.55, respectively. For the oral glucose-lowering drugs group as reference, the cost-effective ratioscost of control fasting blood glucose and control 2 h postprandial blood glucose were -- 184.4 and --89.8 for oral glucose-lowering drugs ＋ insulin injection one time, respectively; the cost-effective ratioscost of control fasting blood glucose and control 2 h postprandial blood glucose were 484.8 and 51.26 for oral glucose-lowering drugs ＋ insulin injection twice, respectively. Conclusion According to the principles of economics,oral medication has the highest cost-effectiveness ratio in the treatment for T2DM,and oral medication ifinsulin injection twice has better therapeutic efficacy.