医保续约后德谷门冬双胰岛素对比甘精胰岛素治疗口服降糖药控制不佳中国2型糖尿病患者的成本-效果

Cost-effectiveness Analysis of Insulin Degludec/Insulin Aspart Versus Insulin Glargine in Insulin-Naive Type 2 Diabetes Mellitus after Renewal of National Reimbursement Drug List in China

目的 评价医保续约后德谷门冬双胰岛素对比甘精胰岛素治疗口服降糖药控制不佳中国2型糖尿病患者的经济性。方法 采用医保续约调整后最新医药价格,运用IQVIACORE糖尿病模型,计算德谷门冬双胰岛素和甘精胰岛素治疗30年的健康产出和卫生成本,并进行增量成本-效果分析。研究基于卫生体系角度,成本包括降糖治疗、疾病管理及并发症治疗的直接医疗成本,健康产出指标为质量调整生命年(quality adjusted life years,QALYs),贴现率使用5%。通过单因素敏感性分析、概率敏感性分析、情境分析验证评价结果的稳健性。结果 基于医保续约调整后的价格,德谷门冬双胰岛素组与甘精胰岛素组比较,治疗2型糖尿病的成本减少了20 595元,QALYs增加了0.133,敏感性分析显示基础分析结果稳健。结论 与甘精胰岛素相比,德谷门冬双胰岛素用于口服降糖药控制不佳2型糖尿病治疗中可以改善患者健康产出并节约成本,是经济性更优的治疗方案。

Objective To evaluate the economics of insulin degludec/aspart(IDegAsp) vs.insulin glargine(IGlar) for the treatment of type 2 diabetes mellitus inadequately controlled with oral antidiabetic drugs after renewal of national reimbursement drug list in China.Methods Based on price of IDegAsp after renewal of national reimbursement drug list,with IQVIA CORE model,the 30-year cost and outcome for IDegAsp and insulin glargine was conducted,and incremental cost-effectiveness analysis was performed.From the perspective of health system,the cost included hyperglycemic treatment,disease management,and complication treatment,and the health outcome index was quality-adjusted life year(QALYs),discount rate was 5%.One-way sensitivity analysis,probability sensitivity analysis and scenario analysis were used to verify the robustness of the results.Results Compared with Insulin Glargine group,Insulin degludec/aspart group could increase 0.133 QALYs and reduce cost of ￥20 595.Sensitivity analyses demonstrated robustness of the results.Conclusion Compared with IGlar,treatment with IDegAsp for poorly controlled oral hypoglycemic agents in Chinese patients with type 2 diabetes can improve health output and save costs,which is a more economical treatment plan.