5种GLP-1RAs治疗二甲双胍控制不佳的2型糖尿病的成本-效用分析  

Cost-utility analysis of 5 kinds of GLP-1RAs in the treatment of poorly controlled type 2 diabetes mellitus treated with metformin

作　　者：谢泽宇 李梦婷 胡佳 陈吉生[1] XIE Zeyu;LI Mengting;HU Jia;CHEN Jisheng(Key Specialty of Clinical Pharmacy,the First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510030,China)

机构地区：[1]广东药科大学附属第一医院临床药学重点专科,广州510030

出　　处：《中国药房》2024年第6期718-723,共6页China Pharmacy

基　　金：中央财政医疗服务与保障能力提升补助资金项目(No.Z155080000004);中国医药教育协会2023年《临床用药卫生技术评估》专项课题(No.2023WSJSPGZXKT-43);广东省第一批药品临床综合评价项目(No.2022-1115-12);广州市民生科技攻关计划项目(No.201803010096)。

摘　　要：目的评估5种胰高血糖素样肽-1受体激动剂(GLP-1RAs)治疗二甲双胍控制血糖不佳的2型糖尿病(T2DM)的长期经济性。方法提取既往发表的荟萃分析及其纳入的随机对照研究(RCT)中患者的基线数据,使用英国前瞻性糖尿病研究结果模型2.1预测各组患者的生存情况、长期疗效和成本,采用成本-效用分析法比较5种GLP-1RAs(利拉鲁肽、利司那肽、艾塞那肽、度拉糖肽和司美格鲁肽)的经济性;采用敏感性分析和情境分析验证基础分析结果的稳定性。结果共纳入21项RCT,6796名患者。生存曲线表明,司美格鲁肽在降低因心血管疾病死亡风险上、度拉糖肽在降低全因死亡风险上较其他GLP-1RAs具有优势。成本-效用分析结果显示,5种方案的经济性从优到劣排序依次为利司那肽、司美格鲁肽、艾塞那肽、度拉糖肽和利拉鲁肽。单因素敏感性分析和概率敏感性分析表明基础分析结果稳健。情境分析结果显示,司美格鲁肽的价格至少降低54.64%,降至369.21元,其对比利司那肽才具有经济性。结论对于使用二甲双胍治疗后血糖控制不佳的我国T2DM患者,临床可考虑优先选择利司那肽和司美格鲁肽。OBJECTIVE To assess the long-term cost-effectiveness of five glucagon-like peptide-1 receptor agonists(GLP-1RAs)in the treatment of poorly controlled type 2 diabetes mellitus(T2DM)treated with metformin.METHODS Baseline data from patients in previously published meta-analysis and included randomized controlled trials(RCTs)were extracted to predict survival,long-term efficacy,and costs for each group using the United Kingdom prospective diabetes study outcome model 2.1.The cost-effectiveness of 5 GLP-1RAs(liraglutide,lixisenatide,exenatide,dulaglutide,and semaglutide)was analyzed by cost-utility analysis.Sensitivity analysis and scenario analysis were also performed to verify the uncertainty of basic analysis results.RESULTS A total of 21 RCTs with 6796 patients were included.Survival analysis curves showed the superiority of semaglutide in reducing the risk of death from cardiovascular disease and dulaglutide in reducing the risk of all-cause mortality over other GLP-1RAs.The cost-utility analysis showed that the five drugs were economically superior to inferior in the order of lixisenatide,semaglutide,exenatide,dulaglutide,and liraglutide;one-way and probabilistic sensitivity analyses indicated that the results were robust.The scenario analysis results indicated that the price of semaglutide should decrease by at least 54.64%to 369.21 yuan,which is cost-effectiveness compared to lixisenatide.CONCLUSIONS For T2DM patients in China with poor glycemic control after treatment with metformin,lixisenatide and semaglutide may be considered as the preferred regimen.

关 键 词：胰高血糖素样肽-1受体激动剂 利司那肽 司美格鲁肽 艾塞那肽 度拉糖肽 利拉鲁肽 成本-效用分析 2型糖尿病 

分 类 号：R956[医药卫生—药学]