吡格列酮二甲双胍治疗中国2型糖尿病的成本-效用分析

Cost-utility analysis of pioglitazone-metformin in the treatment of Chinese type 2 diabetes mellitus patients

目的 评价吡格列酮二甲双胍和西格列汀二甲双胍治疗中国2型糖尿病患者的长期成本和健康收益,以期为临床合理用药提供参考。方法 从卫生体系角度出发,使用CORE糖尿病模型,模拟患者30年的成本和质量调整生命年(quality-adjusted life years,QALYs)。研究所使用的患者基线数据为针对中国糖尿病患者群的流行病学调查,临床数据和成本数据来源于中国地区相关已公开发表的文献,效用数据使用模型默认值,贴现率使用5%。该文对贴现率、研究时限进行了单因素敏感性分析,采用蒙特卡洛模拟进行概率敏感性分析,并对不使用换线治疗的方案进行了情景分析。结果 基础分析结果显示,吡格列酮二甲双胍方案相比于西格列汀二甲双胍方案并发症发生率低,累积QALYs增加0.02(9.49 QALYs vs 9.47 QALYs),同时累积成本降低7 804元(298 214元 vs 306 018元),是具有经济性的绝对优势方案,且敏感性分析结果稳健。结论 相较西格列汀二甲双胍治疗方案,使用吡格列酮二甲双胍可降低患者直接医疗成本,并在长期获得更高健康产出,是一种更具经济性的治疗方案。

Objective To evaluate the long-term cost-effectiveness of pioglitazone-metformin versus sitagliptin-metformin in treating Chinese type 2 diabetes mellitus (T2DM) patients,in order to provide reference for rational drug use in clinic.Methods From the health system perspective,we simulated the quality-adjusted life years(QALYs) of patients over 30 years using the validated CORE diabetes model.Inputs of baseline risk factors were extracted from Chinese epidemiological studies,clinical efficacy and medication cost data were obtained from relevant published resources in China,utility data are model default values.Both outcomes and costs were discounted at 5% annually.In this paper,one-way sensitivity analyses were conducted for discount rates and study durations.Monte Carlo simulation was used for probability sensitivity analysis,and scenario analysis was done for a treatment algorithm without second-line therapy.Results Basic case analysis indicated that,compared with the sitagliptin-metformin regimen,pioglitazone-metformin regimen lowered the incidence of complication,increased cumulative QALYs by 0.02 (9.49 QALYs vs 9.47 QALYs),and reduced total cost by 7 804 yuan (298 214 yuan vs 306 018 yuan).It was an absolute economic advantage scheme and robust sensitivity analysis results.Conclusion In the long-term health economic context,compared with sitagliptin-metformin,pioglitazone-metformin is a more economical treatment option with improved QALYs and reduced direct medical costs among Chinese T2DM patients.