罗格列酮钠和二甲双胍治疗2型糖尿病的药物经济学评价  

Pharmacoeconomic Evaluation of Rosiglitazone Sodium and Metformin in the Treatment of Type 2 Diabetes Mellitus

作　　者：席晓宇[1] 谢雯雯 刘琰[1] 黄蓉 陈磊[1] XI Xiaoyu;XIE Wenwen;LIU Yan;HUANG Rong;CHEN Lei(National Research Center for Drug Policy and Pharmaceutical Industrial Economics,China Pharmaceutical University,Nanjing 210009,China)

机构地区：[1]中国药科大学国家药物政策与医药产业经济研究中心

出　　处：《中国药房》2020年第2期212-216,共5页China Pharmacy

基　　金：国家社会科学基金重大项目(No.15ZDB167);中国药科大学“双一流学科”创新团队建设项目(No.CPU2018GY39)

摘　　要：目的:为临床提供安全、有效、更具经济性的2型糖尿病用药方案建议。方法:构建罗格列酮钠和二甲双胍治疗2型糖尿病的Markov模型,根据2型糖尿病的病情发展特征,用2型糖尿病无并发症、2型糖尿病并发症、死亡等3个状态的动态变化来模拟该疾病的发展。对模型进行回乘分析、队列模拟分析以获取罗格列酮钠和二甲双胍治疗2型糖尿病的长期成本和效果;采用质量调整生命年(QALYs)作为健康产出指标,以糖尿病患者对糖尿病的意愿支付阈值(WTP)12 000元/年判断不同方案的优劣性;对成本、效用和贴现进行敏感性分析,检验分析结果的稳定性。结果:Markov模型成本-效果分析结果显示,罗格列酮钠治疗方案累计成本和健康效用分别为25 164.00元和7.50 QALYs,二甲双胍治疗方案的累计成本和健康效用分别为17 773.36元和7.36 QALYs,罗格列酮钠相对于二甲双胍的增量成本效果比(ICER)为50 983.08元/QALYs,大于WTP,因此二甲双胍治疗组为优势方案。敏感性分析显示,2型糖尿病的健康效用值和贴现率对模型的分析结果影响最大,但在本研究设定的敏感性分析范围内,优势方案结果并未改变。结论:对于2型糖尿病患者,在罗格列酮钠和二甲双胍两种方案中以二甲双胍更具成本-效果优势。OBJECTIVE:To provide reference for safe,effective and economical medication scheme for type 2 diabetes mellitus(T2 DM). METHODS:Markov model was established for rosiglitazone sodium and metformin in the treatment of T2 DM.According to the development characteristics of T2 DM,the development of T2 DM was simulated by the dynamic changes of eventfree,complications and deaths of T2 DM. The long-term cost and effect of rosiglitazone sodium and metformin in the treatment of T2 DM were obtained by regression analysis and queue simulation analysis. QALYs was used as a health output indicator,and the superiority and inferiority of different schemes were judged by the ICER value,and in our study ICER value was WTP(12 000 yuan per year)of diabetics. The sensitivity of cost,utility and discount was analyzed to check the stability of the analysis results.RESULTS:Cost-effectiveness analysis of Markov model showed that the cumulative cost and health effectiveness of rosiglitazone sodium therapy were 25 164.00 yuan and 7.50 QALYs, while 17 773.36 yuan and 7.36 QALYs for metformin;ICER of rosiglitazone sodium relative to metformin was 50 983.08 yuan/QALYs,which was greater than WTP,so the metformin treatment was an advantageous scheme. Sensitivity analysis showed that health utility value and discount rate of diabetes mellitus greatly influenced analysis results of the model,but advantage plan had not changed within the sensiitivity analysis range seted in this study. CONCLUSIONS:For T2 DM,metformin is more cost-effective than rosiglitazone sodium.

关 键 词：2型糖尿病 罗格列酮钠 二甲双胍 成本-效果 MARKOV模型 药物经济学 

分 类 号：R956[医药卫生—药学]