奇正消痛贴膏治疗急性腰扭伤的药物经济学评价

目的基于社会角度,通过成本-效果分析和成本-效用分析评价奇正消痛贴膏与双氯芬酸钠乙二胺乳胶剂治疗急性腰扭伤的经济学优劣,为急性腰扭伤的治疗方案选择提供依据。方法选取2012年7月至2013年6月来自北京、上海、广州和通辽4个城市5所三级医院的急性腰扭伤患者295例,其中奇正消痛贴膏治疗组152例,双氯芬酸钠乙二胺乳胶剂治疗组143例。选取疼痛消失时间为效果指标,质量调整生命年(QALYs)为效用指标,进行成本-效果分析及成本-效用分析。结果与双氯芬酸钠乙二胺乳胶剂治疗组相比,奇正消痛贴膏治疗组疼痛消失时间显著缩短(8.26 d对9.23 d,P<0.001),且获得更多的QALYs(0.0362对0.0359,P=0.597),但治疗成本也更高(308.52元对297.43元,P=0.697)。增量成本效果比(ICER)为-11.43元/d,即减少1天疼痛时间需多花费11.43元。增量成本效用比(ICUR)为36 966.67元/QALY,低于世界卫生组织(WHO)所建议的成本效用阈值115 000元(人均GDP的3倍)。结论在急性腰扭伤的治疗中,外用止痛药物奇正消痛贴膏是非常具有成本-效益的治疗方案。     

贝前列腺素钠对比西洛他唑和沙格雷酯治疗下肢外周动脉闭塞的成本-效用

目的评价贝前列腺素钠分别对比西洛他唑和沙格雷酯在治疗外周动脉疾病(PAD)方面的经济效益,为PAD患者的治疗及医保支付提供循证决策依据。方法利用决策树模型,模拟6个月用药周期内的健康经济产出。模型结果产出包括直接医疗成本、生命质量调整年(QALYs),以及增量成本-效用比(ICUR)。临床疗效数据和患者医疗成本数据通过15位分布全国的PAD领域的临床专家访谈得到,其职称为副主任及以上;效用数据和药品价格分别通过已发表的文献和药品招标采购价格数据库获得;严重不良事件的分支概率进行了网状Meta分析和合理假设。最终对所有的模型参数进行单因素敏感分析和概率敏感性分析,以检测模型的稳健性。结果对于PAD患者,与西洛他唑比较,6个月贝前列腺素钠的治疗方案将会产生0.026 QALYs的健康获益,对应减少806元成本,即ICUR为-31 247元/QALYs;与沙格雷酯比较,贝前列腺素钠将会产生0.017 QALYs的健康获益,对应额外479元的成本产出,即ICUR结果为28 778元/QALYs。单因素敏感性分析显示,模型产出的ICUR值对药物的成本和严重不良事件处理成本最为敏感。概率敏感性分析结果显示,2000次迭代的ICUR均值与确定性结果误差小于5%;成本-效用可接受曲线显示,在一倍中国人均GDP的支付意愿阈值内,贝前列腺素钠的成本-效用有100%的概率占优。结论从中国医保支付的角度,与西洛他唑和沙格雷酯比较,贝前列腺素钠在治疗PAD上具有成本-效用优势。     

基于Markov模型对泛基因型直接抗病毒药物治疗慢性丙型肝炎的药物经济学评价

目的 评价已在中国上市的泛基因型直接抗病毒药物(DAAs)治疗方案与聚乙二醇干扰素(Peg-IFN)为基础的治疗方案用于慢性丙型肝炎(CHC)患者的经济性。方法 从中国医疗卫生体系视角出发,以中国初治CHC患者为目标人群,构建Markov模型。分别模拟非肝硬化和代偿性肝硬化CHC患者在不同治疗方案下获得的质量调整生命年(QALYs)和所花费的直接医疗成本,并计算增量成本-效用比(ICUR)。采用敏感性分析验证结果的稳健性。结果 对于非肝硬化CHC患者,与传统的聚乙二醇干扰素联合利巴韦林(PR)方案比较,3种泛基因型DAAs方案均增加了QALYs而显著降低了终身医疗成本,均为绝对优势方案。对于代偿性肝硬化患者,索磷布韦/维帕他韦方案的QALYs最高而终身治疗成本最低,依然是绝对优势方案。格卡瑞韦/哌仑他韦和索磷布韦联合达拉他韦方案与传统PR方案比较,ICUR分别为3 106.09元/QALY和80 843.45元/QALY;前者小于本研究设定的意愿支付阈值70 892元/QALY(2019年我国人均国内生产总值(GDP)),后者明显小于2019年国内人均GDP的3倍(212676元/QALY)。因此与传统PR方案比较,格卡瑞韦/哌仑他韦和索磷布韦联合达拉他韦方案亦具有显著的药物经济学优势。敏感性分析结果验证了基础分析结果的稳健性。以最具经济学优势的索磷布韦/维帕他韦为对照方案,通过成本-效用分析和阈值分析,测算若格卡瑞韦/哌仑他韦和索磷布韦联合达拉他韦方案达到同等经济性,格卡瑞韦/哌仑他韦、索磷布韦和达拉他韦需分别降价80.5%、80.0%和82.3%。结论 对于非肝硬化和代偿性肝硬化CHC患者,所有泛基因型DAAs治疗方案均具有显著的药物经济学优势,其中索磷布韦/维帕他韦最具成本-效用优势。     

天麻醒脑胶囊治疗血管性疾病的药物经济学评价

目的评价天麻醒脑胶囊治疗血管性痴呆或椎-基底动脉供血不足性眩晕的经济性,为国家医保政策决策提供参考依据。方法从卫生体系角度出发,构建决策树模型,对天麻醒脑胶囊对比复方苁蓉益智胶囊治疗血管性痴呆进行成本-效用分析,产出指标为质量调整生命年(QALY);对天麻醒脑胶囊对比通心络胶囊治疗椎-基底动脉供血不足性眩晕进行成本-效果分析,产出指标为临床有效率。成本数据根据药智网药品价格进行计算,效果数据来源于随机对照试验(RCT)研究。并利用单因素敏感性分析和概率敏感性分析方法分析结果稳健性。结果与复方苁蓉益智胶囊相比,天麻醒脑胶囊治疗血管性痴呆,当治疗周期为24周时,成本低(997.92元vs4213.44元),效果高(0.3354 QALYs vs 0.3313 QALYs),ICER<0;当治疗周期为36周时,成本低(1496.88元vs6320.16元),效果略低(0.5044 QALYs vs 0.5062 QALYs),ICER=2604809.84元/QALY,明显高于意愿支付(WTP)阈值(2020年3倍人均国内生产总值(GDP)为216000元);天麻醒脑胶囊治疗椎-基底动脉供血不足性眩晕,与通心络胶囊对比,成本低(166.32元vs295.68元),效果高(87.5%vs80.0%),ICER<0;敏感性分析显示结果具有稳健性。结论天麻醒脑胶囊治疗血管性痴呆,与复方苁蓉益智胶囊相比具有经济学优势;治疗椎-基底动脉供血不足性眩晕,与通心络胶囊相比具有经济学优势。     

硼替佐米治疗多发性骨髓瘤的药物经济学分析

目的探讨硼替佐米治疗多发性骨髓瘤(MM)的成本-效果/效用,为治疗MM提供决策依据。方法收集2008—2013年广州市某两家三甲医院155例MM患者达到治疗平台期的治疗成本和临床疗效数据,并检索文献中报道的MM患者生存时间和效用值,估计单纯/联合化疗使用硼替佐米与传统化疗治疗MM的成本-效果/效用,并对结果进行敏感性分析。结果硼替佐米组(78例,150218.32元)到达平台期的人均费用高于传统化疗组(77例,110155.00元),单纯使用硼替佐米组(59例,233422.57元)高于联合用药组(19例,142197.20元)。与传统化疗组相比,硼替佐米组总体、单纯使用硼替佐米组和联合用药组每增加一个百分点的总有效率(ORR)的成本分别为1889.78元、6522.09元和1130.50元;每增加一个百分点的完全缓解率(CRR)的成本分别为2457.87元、7179.24元和2373.50元。以质量调整生命年(QALY)为效用指标,硼替佐米组相对传统化疗组的增量成本-效用比范围中值为91053.00元/QALY;以3%的贴现率进行成本贴现,增量成本-效用比范围中值为111983.64元/QALY。敏感性分析结果与上述研究结果一致。结论传统化疗方案治疗MM更为经济,但使用硼替佐米能提高治疗效果;经济条件允许时,推荐使用硼替佐米;同时联合用药方案治疗MM比单纯使用硼替佐米方案更具成本-效果。     

达格列净治疗射血分数降低型心力衰竭的成本-效益

目的 评价添加达格列净治疗中国射血分数降低型心力衰竭（HFrEF）患者的成本-效益。方法 基于DAPA-HF试验数据和相关文献,构建循环周期为3个月、时限为10年的多状态Markov模型,以医疗卫生系统为研究角度,根据是否添加达格列净,分为达格列净组和对照组,模拟添加达格列净治疗HFrEF患者的质量调整生命年（QALYs）和直接医疗成本,比较两组增量成本-效果比（ICER）,并用敏感性分析验证结果的稳健性。结果 与标准治疗方案相比,添加达格列净治疗中国HFrEF患者增加0.46 QALYs,直接医疗总成本增加9 976.01元,ICER值为21 649.33元/QALY,低于我国2022年的人均国内生产总值（GDP）85698元;单因素敏感性分析显示对照组的心血管死亡下限值对ICER值影响最大,概率敏感性分析显示在意愿支付（WTP）阈值为85 698元/QALY时,添加达格列净具有经济性的概率为70.4%。结论 在我国标准治疗方案基础上添加达格列净治疗HFrEF极具成本-效益。     

本维莫德对比卡泊三醇治疗轻中度寻常型银屑病的成本-效用分析

目的采用卫生经济学中的成本-效用分析方法,评价本维莫德对比卡泊三醇治疗轻中度寻常型银屑病的经济性,为医保决策提供科学依据。方法从医保支付者视角出发,构建决策树模型,对本维莫德相比于卡泊三醇治疗轻中度寻常型银屑病患者进行成本-效用分析,评估时间为1年。采用单因素敏感性分析和概率敏感性分析来评估模型结论的可靠性。其中,成本数据来源于药品中标价格,疗效和效用值数据来源于已公开发表的文献和国内相关统计数据。结果基础分析中,本维莫德组相比于卡泊三醇组的增量成本-效用比(ICUR)为-21806元/QALY,具有绝对成本-效用;概率敏感性分析中,在目前阈值条件下(2019年中国1.5倍人均国内生产总值(GDP)为106338元),本维莫德相比于卡泊三醇具有成本-效用的概率为100%。结论在中国成本环境中,对于轻中度寻常型银屑病患者,本维莫德相比于卡泊三醇的成本低,效果好,为绝对优势方案。     

阿普米司特治疗中至重度斑块状银屑病的成本-效果

目的 评价阿普米司特治疗中至重度斑块状银屑病的有效性和经济性。方法 以中至重度斑块状银屑病患者为研究对象,基于医保视角,设置阿达木单抗为对照方案,采用成本-效果分析方法,构建Markov模型并分别对各参比方案下患者治疗状态进行模拟,根据增量净货币收益（INMB）评价阿普米司特相比于阿达木单抗用于中至重度斑块状银屑病治疗中的经济性,并进行敏感性分析来验证结果的稳定性。结果 阿普米司特治疗方案的总成本为384 602.41元,总质量调整生命年（QALYs）为13.16,阿达木单抗治疗方案的总成本为405 920.65元,总QALYs为13.19。阿普米司特方案相比阿达木单抗方案的增量成本为-21 318.24元,增量QALYs为-0.04,INMB为18 414.12元/QALY。敏感性分析中各因素对研究结论无明显影响。结论 在对中至重度斑块状银屑病患者的治疗中,阿普米司特方案相比阿达木单抗方案具有较好的成本-效果优势。     

贝米肝素钠治疗骨科大手术后静脉血栓栓塞症的药物经济学评价

目的 评估贝米肝素钠预防骨科大手术后静脉血栓栓塞症（VTE）的成本-效果,以更好地做出临床用药决策。方法 构建决策树（预防阶段）和Markov模型（长期模拟）,基于中国卫生体系视角评估贝米肝素钠与依诺肝素钠的成本-效果,研究时限为15年。转移概率数据主要来源于临床试验和文献,成本和效用数据主要来源于文献和调研。结果 基础分析结果显示贝米肝素钠具有绝对优势。模型预测贝米肝素钠组相比于比依诺肝素组,15年内可额外增加0.000 4质量调整生命年（QALYs）,且节省2 179元。概率敏感性分析显示,当意愿支付阈值为85 698元/QALY时,贝米肝素钠相比于依诺肝素钠具有成本-效果的概率为98.8%。结论 在中国情境下,骨科大手术后采用贝米肝素钠预防VTE具有成本-效果。     

特利加压素治疗肝硬化门静脉高压食管胃静脉曲张出血的药物经济学评价

目的通过建立Markov模型,对特利加压素、生长抑素及奥曲肽3种治疗肝硬化门静脉高压食管胃静脉曲张出血方案进行成本-效用分析,为临床用药提供循证依据。方法建立Markov模型,模型包括出血、稳定、死亡3个状态。模型的主要结果为总成本、质量调整生命年(quality adjusted life years,QALYs)和增量成本-效用比,参考药品价格、Markov各状态治疗成本、健康效用值、状态转移概率建立模型,采用半周期校正,对3种方案的有效性和经济性进行评价。并对特利加压素价格、奥曲肽价格、再出血率、健康效用值进行单因素敏感性分析探讨参数的不确定性。同时,加入特利加压素死亡率随周期递减的情境分析,再次比较3种药物的经济性。结果在3种用药方案中,特利加压素相对于生长抑素,成本较低,产出较高,具有绝对药物经济学优势;特利加压素相对于奥曲肽,用药方案成本较高,产出也较高,每多获得1QALY的成本处于可接受标准内,具有相对药物经济学优势。敏感性分析结果显示,在特利加压素和生长抑素的方案比较中,再出血率对研究结果影响最大;而在特利加压素和奥曲肽的方案比较中,健康效用对研究结果影响最大。结论特利加压素与生长抑素、奥曲肽相比具有经济学优势。     

Economic evaluation for the US of nab-paclitaxel plus gemcitabine versus FOLFIRINOX versus gemcitabine in the treatment of metastatic pancreas cancer

Background: Nab-paclitaxel plus gemcitabine (NAB-P?+?GEM) and FOLFIRINOX have shown superior efficacy over gemcitabine (GEM) in the treatment of metastatic pancreatic ductal adenocarcinoma (mPDA). Although the incremental clinical benefits are modest, both treatments represent significant advances in the treatment of a high-mortality cancer. In this independent economic evaluation for the US, the aim was to estimate the comparative cost-utility and cost-effectiveness of these three regimens from the payer perspective.

Methods: In the absence of a direct treatment comparison in a single clinical trial, the Bucher indirect comparison method was used to estimate the comparative efficacy of each regimen. A Markov model evaluated life years (LY) and quality-adjusted life years (QALY) gained with NAB-P?+?GEM and FOLFIRINOX over GEM, expressed as incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR). All costs and outcomes were discounted at 3%/year. The impact of parameter uncertainty on the model was assessed by probabilistic sensitivity analyses.

Results: NAB-P?+?GEM was associated with differentials of +0.180 LY and +0.127 QALY gained over GEM at an incremental total cost of $25,965; yielding an ICER of $144,096/LY and ICUR of $204,369/QALY gained. FOLFIRINOX was associated with differentials of +0.368 LY and +0.249 QALY gained over GEM at an incremental total cost of $93,045; yielding an ICER of $253,162/LY and ICUR of $372,813/QALY gained. In indirect comparison, the overall survival hazard ratio (OS HR) for NAB-P?+?GEM vs FOLFIRINOX was 0.79 (95%CI?=?0.59–1.05), indicating no superiority in OS of either regimen. FOLFIRINOX had an ICER of $358,067/LY and an ICUR of $547,480/QALY gained over NAB-P?+?GEM. Tornado diagrams identified variation in the OS HR, but no other parameters, to impact the NAB-P?+?GEM and FOLFIRINOX ICURs.

Conclusions: In the absence of a statistically significant difference in OS between NAB-P?+?GEM and FOLFIRINOX, this US analysis indicates that the greater economic benefit in terms of cost-savings and incremental cost-effectiveness and cost-utility ratios favors NAB-P?+?GEM over FOLFIRINOX.     

Cost-utility of albiglutide versus insulin lispro,insulin glargine,and sitagliptin for the treatment of type 2 diabetes in the US

Objective To compare the cost-utility of the glucagon-like peptide-1 receptor agonist albiglutide with those of insulin lispro (both in combination with insulin glargine), insulin glargine, and the dipeptidyl peptidase-4 inhibitor sitagliptin, representing treatments along the type 2 diabetes treatment continuum.

Methods The Centre for Outcomes Research and Effectiveness (CORE) Diabetes Model was used for the cost-utility analysis. Data from three Phase 3 clinical trials (HARMONY 6, HARMONY 4, and HARMONY 3) evaluating albiglutide for the treatment of patients with type 2 diabetes were used for the baseline characteristics and treatment effects. Utilities and costs were derived from published sources.

Results Albiglutide treatment was associated with an improvement in mean quality-adjusted life expectancy of 0.099, 0.033, and 0.101 years when compared with insulin lispro, insulin glargine, and sitagliptin, respectively. Over the 50-year time horizon, mean total costs in the albiglutide arm were $4332, $2597, and $2223 more than in the other respective treatments. These costs resulted in an incremental cost-utility ratio of $43,541, $79,166, and $22,094 per quality-adjusted life-year (QALY) gained for albiglutide vs insulin lispro, insulin glargine, and sitagliptin, respectively. At a willingness-to-pay threshold of $50,000 per QALY gained, there was a 53.0%, 41.5%, and 67.5% probability of albiglutide being cost-effective compared with the other respective treatments.

Limitations This analysis was an extrapolation over a 50-year time horizon based on relatively short-term data obtained during clinical trials. It does not take into account potential differences between the respective treatments in adherence and persistence that can influence both effects and costs.

Conclusions Albiglutide represents a reasonable treatment option for patients with type 2 diabetes based on its cost-utility, relative to insulin lispro, insulin glargine, and sitagliptin.     

The cost-effectiveness of somatropin treatment for short children born small for gestational age (SGA) and children with growth hormone deficiency (GHD) in Sweden

Abstract

Objective: Reduction in health-related quality of life is common in children born small for gestational age (SGA) or children with growth hormone deficiency (GHD). Growth hormone treatment with somatropin in these children leads to normalisation of height. The aim of this study was to determine whether somatropin is a cost-effective treatment option for short children born SGA and GHD children in Sweden.

Methods: A Markov decision-tree model was used to calculate the relative costs and health benefits associated with somatropin treatment over the lifetime of SGA and GHD children, compared with no treatment. The analysis was undertaken from a Swedish Health Service perspective. As quality-adjusted life-year (QALY) data were not obtained directly in the clinical studies, a degree of uncertainty is related to these results. Sensitivity analyses assessed the degree of uncertainty surrounding central parameters.

Results: For short children born SGA, somatropin treatment was associated with an additional 3.29 QALYs at an incremental cost of 792,489 SEK (Swedish Krona), compared with no treatment. For GHD, somatropin treatment resulted in 3.25 additional QALYs at an incremental cost of 391,291 SEK. This equates to an incremental cost per QALY of 240,831 SEK and 120,494 SEK for SGA and GHD, respectively, below a cost-effectiveness threshold of 500,000–600,000 SEK/QALY.

Conclusions: Somatropin is a cost-effective treatment strategy in Sweden for children with GHD and SGA. To overcome present study limitations future clinical research should incorporate appropriate quality of life questionnaires.     

Cost-utility of celecoxib use in different treatment strategies for osteoarthritis and rheumatoid arthritis from the Quebec healthcare system perspective

Abstract

Objective: To assess the cost-utility of celecoxib in three treatment strategies for arthritis in Quebec, considering both upper gastrointestinal (GI) and cardiovascular (CV) events.

Methods: A Markov analytic framework was used to model patients with osteoarthritis and rheumatoid arthritis at low/average and high risk of GI and CV toxicity over 5 years with monthly cycles. Treatment strategies were modelled in line with Canadian clinical practice. In first-line treatment, patients started on celecoxib; second-line, patients started on a non-selective non-steroidal anti-inflammatory drug (NSAID) and switched to celecoxib after a first GI event; third-line, patients started on a non-selective NSAID, added a proton pump inhibitor (PPI) after a first GI event, and switched to celecoxib after a second GI event (while maintaining the PPI). Model inputs were determined through comprehensive literature searches (MEDLINE and EMBASE) from 1995 to 2006. Included studies evaluated GI (dyspepsia, uncomplicated and complicated ulcers, death) and CV (myocardial infarction, stroke, death) events. Drug and procedure costs were derived from Canadian published sources (Can$2005).

Results: Total costs per patient for celecoxib first-, second-, and third-line treatment were Can$4,790, $3,390, and $3,466, and total quality-adjusted life-years (QALY) were 3.251, 3.231, and 3.230, respectively. In all risk categories, celecoxib second-line was less costly and as effective as celecoxib third-line, producing savings to the healthcare system. Although celecoxib first-line generated incremental expenditures versus celecoxib second-line, it was also more effective. The resulting cost-utility ratio for the high-risk population was Can$54,696/QALY. Based on this analytical approach, a treatment strategy where celecoxib is used before the combination of a non-selective NSAID plus a PPI possesses cost advantages for the Quebec provincial drug programme. One-way sensitivity analysis (varying GI and CV event rates, utilities, and cost) generally showed second-line treatment with celecoxib as the dominant strategy compared with third-line treatment with celecoxib.

Conclusion: Although effectiveness of second- and third-line celecoxib use is similar, total cost is lower for second-line. These results suggest that the use of celecoxib before the combination of a non-selective NSAID plus a PPI is relatively cost-effective in the treatment of arthritis pain and support the full benefit listing of celecoxib in Quebec's drug programme.     

Impact on health outcome and costs of influenza treatment with oseltamivir in elderly and high-risk patients

Summary

The main objective of this study was to evaluate health outcomes and costs to the healthcare payer of treating influenza with oseltamivir in a high-risk population. Data from published literature, clinical trials and public sources were used to develop a decision-analytic model simulating a high-risk population in the UK. The underlying clinical pathway predicts morbidity and mortality due to influenza, and its specified complications for the two influenza treatment strategies—oseltamivir and usual care. Health outcomes (quality-adjusted life years [QALYs], days to return to normal activity) and costs were estimated for events in the model. Robustness of the results was tested by probabilistic, univariate and multivariate sensitivity analyses.

Treatment with oseltamivir within 48 hours results in reduced morbidity, which translates into faster recovery and return to normal activity. Economic evaluation showed that treatment with oseltamivir in a high-risk population in the UK is a cost-effective strategy in all analysed scenarios with cost-utility ratios between £225 and £17,900 per QALY gained.

Treatment with oseltamivir is effective in terms of health outcome and cost for high-risk patients from the perspectives of the individual patient and healthcare payer.     

Cost effectiveness analysis of immunotherapy in patients with grass pollen allergic rhinoconjunctivitis in Germany

Abstract

Objectives:

An economic evaluation was conducted to assess the outcomes and costs as well as cost-effectiveness of the following grass-pollen immunotherapies: OA (Oralair; Stallergenes S.A., Antony, France) vs GRZ (Grazax; ALK-Abelló, Hørsholm, Denmark), and ALD (Alk Depot SQ; ALK-Abelló) (immunotherapy agents alongside symptomatic medication) and symptomatic treatment alone for grass pollen allergic rhinoconjunctivitis.

Methods:

The costs and outcomes of 3-year treatment were assessed for a period of 9 years using a Markov model. Treatment efficacy was estimated using an indirect comparison of available clinical trials with placebo as a common comparator. Estimates for immunotherapy discontinuation, occurrence of asthma, health state utilities, drug costs, resource use, and healthcare costs were derived from published sources. The analysis was conducted from the insurant’s perspective including public and private health insurance payments and co-payments by insurants. Outcomes were reported as quality-adjusted life years (QALYs) and symptom-free days. The uncertainty around incremental model results was tested by means of extensive deterministic univariate and probabilistic multivariate sensitivity analyses.

Results:

In the base case analysis the model predicted a cost-utility ratio of OA vs symptomatic treatment of €14,728 per QALY; incremental costs were €1356 (95%CI: €1230; €1484) and incremental QALYs 0.092 (95%CI: 0.052; 0.140). OA was the dominant strategy compared to GRZ and ALD, with estimated incremental costs of ?€1142 (95%CI: ?€1255; ?€1038) and ?€54 (95%CI: ?€188; €85) and incremental QALYs of 0.015 (95%CI: ?0.025; 0.056) and 0.027 (95%CI: ?0.022; 0.075), respectively. At a willingness-to-pay threshold of €20,000, the probability of OA being the most cost-effective treatment was predicted to be 79%. Univariate sensitivity analyses show that incremental outcomes were moderately sensitive to changes in efficacy estimates. The main study limitation was the requirement of an indirect comparison involving several steps to assess relative treatment effects.

Conclusion:

The analysis suggests OA to be cost-effective compared to GRZ and ALD, and a symptomatic treatment. Sensitivity analyses showed that uncertainty surrounding treatment efficacy estimates affected the model outcomes.     

Cost effectiveness of rimonabant use in patients at increased cardiometabolic risk: estimates from a Markov model

Summary

Rimonabant, the first selective CB-1 receptor blocker, is expected to reduce cardiometabolic risk substantially. This study assesses the economics of such treatment in patients at elevated cardiometabolic risk.

A Markov model was developed using data from the Rimonabant in Obesity (RIO) trial, published risk equations, and UK cost and utility data. Patients begin either in a diabetic or a non-diabetic state and can transition to cardiovascular disease or to death (based on UK life tables). Transitions to diabetes and subsequent cardiovascular events are also counted. Resource use due to events and long-term management were translated to UK costs (2005 GBP). Tariffs for events and states were applied to age-dependent utilities. Extensive univariate and multivariate probabilistic sensitivity analyses were carried out.

Over 10 years, 8% will suffer a cardiovascular event with a loss of more than 1,000 quality-adjusted life years (QALYs) and a cost of more than £500,000 per 1,000 patients. Projecting risk for a lifetime, 1 year of rimonabant use is estimated to gain >65 QALYs at £8,574/QALY. In probabilistic sensitivity analysis, incremental cost-effectiveness ratios varied from £2,657 to £22,141/QALY.

Based on the metabolic effects seen in clinical trials, rimonabant should reduce cardiovascular risk in obese or overweight people at reasonable cost.     

Evaluation of the long-term cost-effectiveness of liraglutide therapy for patients with type 2 diabetes in France

Objectives:

The present study aimed to compare the projected long-term clinical and cost implications associated with liraglutide, sitagliptin and glimepiride in patients with type 2 diabetes mellitus failing to achieve glycemic control on metformin monotherapy in France.

Methods:

Clinical input data for the modeling analysis were taken from two randomized, controlled trials (LIRA-DPP4 and LEAD-2). Long-term (patient lifetime) projections of clinical outcomes and direct costs (2013 Euros; €) were made using a validated computer simulation model of type 2 diabetes. Costs were taken from published France-specific sources. Future costs and clinical benefits were discounted at 3% annually. Sensitivity analyses were performed.

Results:

Liraglutide was associated with an increase in quality-adjusted life expectancy of 0.25 quality-adjusted life years (QALYs) and an increase in mean direct healthcare costs of €2558 per patient compared with sitagliptin. In the comparison with glimepiride, liraglutide was associated with an increase in quality-adjusted life expectancy of 0.23 QALYs and an increase in direct costs of €4695. Based on these estimates, liraglutide was associated with an incremental cost-effectiveness ratio (ICER) of €10,275 per QALY gained vs sitagliptin and €20,709 per QALY gained vs glimepiride in France.

Conclusion:

Calculated ICERs for both comparisons fell below the commonly quoted willingness-to-pay threshold of €30,000 per QALY gained. Therefore, liraglutide is likely to be cost-effective vs sitagliptin and glimepiride from a healthcare payer perspective in France.