地特胰岛素和甘精胰岛素治疗2型糖尿病的成本-效果分析

Cost-effectiveness of insulin detemir and insulin glargine in treatment of type 2 diabetes

目的:评价地特胰岛素和甘精胰岛素应用于中国2型糖尿病患者的长期健康结果及经济成本。方法:运用公开发表并经过有效性验证的CORE糖尿病模型,基于PREDICTIVE临床研究中韩国亚组的治疗效果数据和已公开发表的中国患者疾病风险和成本数据,模拟中国2型糖尿病患者应用甘精胰岛素和地特胰岛素的长期期望寿命、质量调整生命年和直接医疗成本,并进行成本-效果分析。结果:与甘精胰岛素相比,地特胰岛素组患者的人均期望寿命增加0.061年,质量调整生命年增加0.484 QALY,直接医疗总成本减少2 869元。敏感度分析显示了研究结果的稳健型。结论:基于PREDICTIVE研究中韩国亚组的治疗效果和已公开发表的中国患者疾病风险和成本数据,模拟结果提示与甘精胰岛素相比,中国2型糖尿病患者应用地特胰岛素不仅能提高预期寿命和质量调整生命年,而且降低总直接医疗成本,是成本节约的治疗方案。

OBJFK-TIVE To evaluate the long-term health outcomes and direct medical costs of switching from insulin glargine to insulin detemir in patients with type 2 diabetes （T2DM） in China. METHODS The CORE diabetes model was used to project life expectancy, quality-adjusted life years （QALYs） and long-term medical costs of patients with T2DM in China. Main input included treatment data from the Korea subgroup of the Predictable Results and Experience in Diabetes through Intensification and Control to Target： an International Variability Evaluation （PREDICTIVE） study and disease risk factor and cost information from Chinese studies. RESULTS Switching from insulin glargine to insulin detemir was associated with increase in patient life expectancy by 0. 061 year and 0. 484 QALYs, and decrease in total cost by 2 869 Yuan. Sensitivity analyses demonstrated robustness of the results. CONCLUSION Switching to insulin detemir was associated with improvements in life expectancy and was cost-saving in patients with T2DM poorly controlled with insulin glargine in China.