胰岛素强化治疗新诊断2型糖尿病患者成本-效果分析

Cost-effectiveness analysis of insulin intensive therapy for newly diagnosed type 2 diabetes mellitus patients

目的分析3种胰岛素强化治疗方案的成本-效果,为选择临床治疗方案提供参考。方法对新诊断2型糖尿病患者随机分为3组。A组仅给予持续皮下注射胰岛素(CSII),B组给予CSII联合二甲双胍和吡格列酮,C组给予CSII联合西格列汀。收集治疗前后的空腹血糖(FPG)、餐后2 h血糖(2hPG)、血糖达标时间、住院天数、低血糖发生次数及成本,比较3种方案的成本-效果。结果各组患者经治疗后FPG、2hPG均下降(均P<0.01),3组的血糖达标时间、住院天数及低血糖发生次数差异均有统计学意义(均P<0.01)。A、B、C组有效率的成本-效果比分别为139.37、134.29、135.66。以A组为对照,B组和C组的增量成本-效果比分别为25.52、53.85。敏感性分析支持基础分析结果。结论CSII联合二甲双胍和吡格列酮治疗新诊断2型糖尿病患者是最经济、有效的方案;对于低血糖发生危险性高的患者,可选CSII联合西格列汀。

Objective To analyze the cost-effectiveness of three kinds of different insulin intensive treatment regimes,and to provide a reference for the selection of clinical treatment regimens.Methods Patients with newly diagnosed type 2 diabetes mellitus(T2DM)were randomly divided into three groups. Group A,continuous subcutaneous insulin infusion(CSII)alone;group B,CSII combined with metformin and pioglitazone;group C,CSII combined with sita-gliptin. Fasting blood glucose(FPG)and 2-hour postprandial blood glucose(2hPG)before and after treatment,the days of reaching the target of blood glucose,the hospitalization days,the frequency of hypoglycemia,and the costs of the different regimes were recorded,and the cost-effectiveness of the three regimes was compared.Results All groups showed significantly decreased FPG and 2hPG post-treatment(all P<0.01),and the days of reaching the target of blood glucose,thehospitalization days,and the frequency of hypoglycemia among the three groups were statistically significant(all P<0.01). The cost-effectiveness ratio of the effective rate was 139.37,134.29,and 135.66,respectively. Compared with group A,the incremental cost-effectiveness ratios for group B and group C were 25.52 and 53.85,respectively. The resultsof sensitivity analysis supported the results of basic analysis.Conclusion CSII combined with metformin and pioglitazone therapy is the most cost-effective treatment for newly diagnosed T2DM. For patients with a high risk of hypoglycemia,CSII combined with sitagliptin is available.