格列美脲联合二甲双胍、阿卡波糖、吡格列酮治疗2型糖尿病的成本-效果分析

Cost-effectiveness Analysis of Glimepiride Combined with Metformin,Acarbose and Pioglitazone in the Treatment of Type 2 Diabetes Mellitus

目的探讨格列美脲联合二甲双胍、阿卡波糖、吡格列酮治疗2型糖尿病(diabetes mellitus type 2,T2DM)的效果与经济性。方法选取2020年4月—2022年4月南京市六合区中医院收治的84例T2DM患者作为研究对象,依据随机数表法将患者分为A组、B组和C组,每组28例,分别采用格列美脲+二甲双胍、格列美脲+阿卡波糖、格列美脲+吡格列酮治疗。比较3组患者降糖治疗总有效率、胰岛素抵抗指数(HOMA-IR)、胰岛素β细胞功能(HMOA-β),增量成本效益比(ICER)。结果3组患者的降糖治疗总有效率分别为92.86%、96.43%、96.43%,比较差异无统计学意义(P>0.05);3组患者治疗后HOMA-IR水平均低于治疗前,HOMA-β高于治疗前,差异有统计学意义(P<0.05)。但3组治疗后的HOMA-IR、HOMA-β比较,差异无统计学意义(P>0.055)。B组成本高于A组与C组,但效果劣于A组与C组,为绝对劣势方案。C组成本高于A组15.61元,但有效率也高于A组的3.57%,ICER增量成本为5014.44元,低于1倍中国2021年人均GDP的经济性阈值(80976元)。结论格列美脲联合二甲双胍、阿卡波糖、吡格列酮治疗T2DM,降糖效果理想,但联合二甲双胍治疗获得理想的经济收益,可作为一种理想的降糖方案。

Objective To investigate the effect and economy of glimepiride combined with metformin,acarbose and pioglitazone in the treatment of diabetes mellitus type 2(T2DM).Methods A total of eighty-four T2DM patients admitted to Liuhe District Hospital of Traditional Chinese Medicine in Nanjing from April 2020 to April 2022 were selected as the research objects.According to random number table method,the patients were divided into group A,group B and group C,with twenty-eight samples in each group.Glimepiride+metformin,glimepiride+acarbose,and glimepiride+pioglitazone were respectively treated.The total effective rate of hypoglycemic treatment,homeostasismodel assessment-Insulin Resistance(HOMA-IR),homeostasismodel assessment-β(HOMA-β),and Incremental Cost-Effectiveness Ratio(ICER)were compared in the three groups of patients.Results The total effective rates of hypoglycemic treatment in the three groups of patients were 92.86%,96.43%and 96.43%,respectively,the difference was not statistically significant(P>0.05).The level of HOMA-IR after treatment in the three groups of patients was lower than that before treatment,and HMOA-βwas higher than that before treatment,the difference was statistically significant(P<0.05).But the HOMA-IR and HOMA-βof three groups after treatment were compared,the difference was not statistically significant(P>0.05);the composition of group B was higher than that of group A and C,but the effect was worse than that of group A and C,which was an absolutely inferior scheme.The component cost of C was 15.61 yuan higher than that of Group A,but the effective rate was also 3.57%higher than that of Group A.The ICER incremental cost was 4452.48 yuan,which was lower than the economic threshold of one times China´s per capita GDP in 2021(80976 yuan).Conclusion Glimepiride combined with metformin,acarbose and pioglitazone has an ideal hypoglycemic effect in the treatment of T2DM,but combined with metformin can achieve ideal economic benefits and can be used as an ideal hypoglycemic regimen.