利拉鲁肽与罗格列酮、格列美脲、艾塞那肽和甘精胰岛素治疗2型糖尿病患者的短期成本-效果比较

目的以第26周末达到HbA1c<7%、无体重增加和无低血糖事件作为糖尿病综合管理的有效复合终点,分析在中国2型糖尿病患者治疗中每日一次1.2mg利拉鲁肽相比罗格列酮、格列美脲、艾塞那肽和甘精胰岛素的经济性。方法利用利拉鲁肽全球Ⅲ期临床试验(LEADTM)的临床数据计算每日一次1.2mg利拉鲁肽相比罗格列酮、格列美脲、艾塞那肽和甘精胰岛素的成功治疗1例患者的成本。成本包括药物、针头、自我血糖监测,以及处置严重不良事件(SAE)、低血糖事件和体重干预的成本,效果指标为复合终点达标率,并进行单因素敏感度分析。结果在使用研究药物治疗26周后,相对罗格列酮、格列美脲、艾塞那肽和甘精胰岛素,每日一次1.2mg利拉鲁肽治疗每100例患者分别使额外26例、24例、7例和17例患者达到复合终点,利拉鲁肽成功治疗1例患者所需成本小于对应比较治疗方案。敏感度分析支持了结果的稳健性。结论相比罗格列酮、格列美脲、艾塞那肽和甘精胰岛素,利拉鲁肽是具有成本-效果的治疗方案。

Short-term Cost-effectiveness of Liraglutide Versus Rosiglitazone、Glimepiride、Exenatide and Insulin Glargine in Chinese Patients with type 2 Diabetes

Objective The aim of this study was to evaluate the cost-effectiveness of liraglutide 1.2mg once daily versus other commonly used anti-diabetic drugs in patients with type 2 diabetes （T2DM）achieving a composite endpoint of HbA1c〈7.0%,no weight gain,and no hypoglycaemia at week 26.Methods The study compared anti-diabetic drugs with clinical evidence in the〝Liraglutide Effect and Action in Diabetes（LEADTM）〞clinical trial program,including rosiglitazone,glimepiride,exenatide and insulin glargine.Results were calculated as cost per patient successful y treated to the target composite end point.Effectiveness data of patients achieving the composite endpoint of HbA1c〈7.0%,no weight gain,and no hypoglycaemia at week 26 were derived from a meta-analysis.Medical costs included the cost of drugs, needles,self-monitoring of blood glucose（SMBG） strips,hypoglycaemia,weight loss and serious adverse events.One way sensitivity analysis was performed.Results Within 26 weeks,comparing with rosiglitazone,glimepiride, exenatide and insulin glargine,liraglutide 1.2mg made 26,24,7 and 17 additional patients achieve the composite end point every 100 patients respectively.The cost per patient successful y treated with liraglutide to the target composite end point is lower than al the other comparators.Sensitivity analyses demonstrated robustness of the results.Conclusion The analysis demonstrates that liraglutide was a cost-effective approach Cascompared with rosiglitazone,glimepiride,exenatide and insulin glargine.