基于Markov模型的聚乙二醇洛塞那肽与二甲双胍联合治疗2型糖尿病的药物经济学评价  

Pharmacoeconomic evaluation of polyethylene glycol loxenatide combined with metformin in type 2 diabetes mellitus based on the Markov model

作　　者：马博乐 赵振宇[1,2,3,4] MA Bole;ZHAO Zhenyu(Department of Pharmacy,Chu Hsien-I Memorial Hospital of Tianjin Medical University,Tianjin 300134,China;Tianjin Institute of Endocrinology,Tianjin 300134,China;NHC Key Laboratory of Hormones and Development,Tianjin 300134,China;Tianjin Key Laboratory of Metabolic Diseases,Tianjin 300134,China)

机构地区：[1]天津医科大学朱宪彝纪念医院药剂科,天津300134 [2]天津医科大学朱宪彝纪念医院天津市内分泌研究所,天津300134 [3]天津医科大学朱宪彝纪念医院国家卫健委激素与发育重点实验室,天津300134 [4]天津医科大学朱宪彝纪念医院天津市代谢性疾病重点实验室,天津300134

出　　处：《中国医院药学杂志》2023年第19期2194-2197,2207,共5页Chinese Journal of Hospital Pharmacy

基　　金：天津市医学重点学科(专科)建设项目(编号:TJYXZDXK-032A)。

摘　　要：目的:对聚乙二醇洛塞那肽与二甲双胍联合治疗2型糖尿病(T2DM)进行经济学评价,为单用二甲双胍血糖控制不佳的T2DM患者临床用药选择、合理用药以及医保决策提供依据。方法:建立0.1 mg聚乙二醇洛塞那肽与二甲双胍联合治疗和单用二甲双胍治疗T2DM的Markov模型,通过队列模拟预测各方案长期的成本与效用;以2022年人均国内生产总值(GDP)的3倍作为意愿支付阈值(willingness to pay,WTP),分析增量成本-效果比(incremental cost effectiveness ratio,ICER),并对所得结果进行单因素敏感性分析及概率敏感性分析。结果:相较单药治疗,联合治疗方案的累计效用改善0.48QALYs,患并发症的概率减少10.61%,死亡率减少6.62%;ICER为147033.58元/QALYs,小于WTP,具有成本-效用优势,增加的成本可接受;敏感度分析显示研究结果稳定性良好,联合治疗方案具有成本-效用优势的概率为97.2%。结论:对于单用二甲双胍血糖控制不佳的T2DM患者,0.1 mg聚乙二醇洛塞那肽与二甲双胍联合治疗属于优势方案。OBJECTIVE To perform the economical evaluation of polyethylene glycol loxenatide combined with metformin in the treatment of type 2 diabetes,so as to provide basis for clinical drug selection,rational drug use and medical insurance decision for patients with poor blood glucose control treated with metformin alone.METHODS Markov model for 0.1 mg polyethylene glycol loxenatide combined with metformin or metformin alone in the treatment of type 2 diabetes was established.Cohort simulation in Markov model was applied to obtaining long-term effect and cost of each regimen.With three times GDP in 2022 as the willingness payment,the incremental cost-utility ratio was analyzed.The single factor sensitivity analysis and probability sensitivity analysis were carried out to ensure the stability of the analysis results.RESULTS Compared with monotherapy,the cumulative utility of the combination therapy was improved by 0.48 QALYs,the probability of complications was reduced by 10.61%and the mortality rate was decreased by 6.62%;the ICER was 147033.58 yuan/QALYs,which was less than WTP,with a cost-utility advantage and acceptable increased cost.The results of the sensitivity analysis showed that the study was well stable,with the probability of a cost-utility advantage of the combination regimen being 97.2%.CONCLUSION For T2DM patients with poor glucose control treated with metformin alone,the combination of 0.1 mg polyethylene glycol loxenatide with metformin is a predominant regimen.

关 键 词：聚乙二醇洛塞那肽 二甲双胍 2型糖尿病 MARKOV模型 药物经济学 

分 类 号：R956[医药卫生—药学]