基于净效益回归框架的胰岛素类似物与人胰岛素治疗2型糖尿病的成本-效果分析  

Cost-effectiveness Analysis of Insulin Analogues and Human Insulin in the Treatment of Type 2 Diabetes Mellitus Based on Net-benefit Regression Framework

作　　者：邓丹[1] 明鑫 尹锦 王怡 钱妍[4] DENG Dan;MING Xin;YIN Jin;WANG Yi;QIAN Yan(School of Public Health and Management,Chongqing Medical University,Chongqing 400016,China;Dept.of Quality Management,Chongqing Health Center for Women and Children,Chongqing 401147,China;Chengdu Tianfu New Area Center for Disease Control and Prevention,Chengdu 610213,China;Dept.of Pharmacy,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学公共卫生与管理学院,重庆400016 [2]重庆市妇幼保健院质量管理科,重庆401147 [3]成都天府新区疾病预防控制中心,成都610213 [4]重庆医科大学附属第二医院药学部,重庆400010

出　　处：《中国药房》2020年第23期2877-2881,共5页China Pharmacy

基　　金：重庆市自然科学基金资助项目(No.cstc2018jcyjAX0184);重庆市高校人文社会科学类研究项目(No.17SKG025)。

摘　　要：目的:比较胰岛素类似物与人胰岛素治疗2型糖尿病的成本-效果,减轻患者疾病经济负担,同时为非随机化的药物经济学研究提供新思路。方法:采用重庆市某三级甲等医院的回顾性数据,共纳入533例2型糖尿病患者为研究对象,通过倾向性评分匹配平衡组间差异,构建净效益回归框架来分析胰岛素类似物与人胰岛素治疗2型糖尿病的成本-效果。结果:两种治疗方案的疗效与成本存在正向关系——胰岛素类似物的疗效优于人胰岛素,两者总有效率相差14.5%;相应的治疗成本也是胰岛素类似物高于人胰岛素,平均总成本相差960.3元。每增加1个单位临床效果(即总有效率),胰岛素类似物组患者需要比人胰岛素组多花费66.23元。净效益回归分析结果显示,患者选择治疗方案的支付意愿临界值为16947.5元。结论:当患者的最大支付意愿大于16947.5元时,适宜选择胰岛素类似物治疗方案;反之,则适宜选择人胰岛素治疗方案。倾向性评分技术应用于净效益回归分析可以为非随机化药物经济学拓宽可用数据的来源。OBJECTIVE:To compare the cost-effectiveness of insulin analogues and human insulin in the treatment of type 2 diabetes mellitus,to reduce economic burden of patients,and to provide new ideas for non-randomized pharmacoeconomic research.METHODS:Retrospective data of a Third-grade Class-A hospital were adopted and 533 patients with type 2 diabetes were taken as object to balance the difference between groups through propensity score matching,and construct net-benefit regression framework so as to analyze the cost-effectiveness of insulin analogues and human insulin in the treatment of type 2 diabetes mellitus.RESULTS:There was a positive relationship between the efficacy and cost of the two therapeutic schemes,i.e.insulin analogues were more effective than human insulin,and the difference of total effective rate between the two schemes was 14.5%.The corresponding treatment cost of insulin analogues was higher than that of human insulin,and the average total cost difference was 960.3 yuan.The cost of insulin analogues was 66.23 yuan more than that of human insulin for each additional unit of clinical effect(total effective rate).Results of net-benefit regression analysis showed that critical value of willingness to pay of therapy plan was 16947.5 yuan.CONCLUSIONS:When the willingness to pay is more than 16947.5 yuan,the insulin analogue scheme is suitable;on the contrary,the human insulin analogue scheme is suitable.The propensity scoring technology used for the net-benefit regression analysis can broaden the source of avaliable data for non-randomized pharmacoeconomic evaluation.

关 键 词：2型糖尿病 人胰岛素类似物 人胰岛素 倾向性评分匹配 净效益回归框架 成本-效果分析 

分 类 号：R587.1[医药卫生—内分泌] R956[医药卫生—内科学]