司美格鲁肽对比卡格列净治疗二甲双胍控制不佳的2型糖尿病患者的成本-效用分析  

Cost-utility analysis of semaglutide versus canagliflozin in patients with type 2 diabetes poorly controlled with metformin

作　　者：徐跃洳 王钰博[2,3] 潘慧敏 单慧亭 陈迹[2,3] 杨建华 XU Yueru;WANG Yubo;PAN Huimin;SHAN Huiting;CHEN Ji;YANG Jianhua(School of Pharmacy,Xinjiang Medical University,Urumqi 830011,China;Dept.of Pharmacy,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China;Xinjiang Key Laboratory of Clinical Drug Research,Urumqi 830011,China)

机构地区：[1]新疆医科大学药学院,乌鲁木齐830011 [2]新疆医科大学第一附属医院药学部,乌鲁木齐830011 [3]新疆药物临床研究重点实验室,乌鲁木齐830011

出　　处：《中国药房》2025年第9期1087-1092,共6页China Pharmacy

基　　金：创新药物上市后临床研究科研专项(No.WKZX2023CX210008);新疆维吾尔自治区药品临床综合评价项目(No.XJWJYZ202403)。

摘　　要：目的对二甲双胍控制不佳的2型糖尿病(T2DM)患者使用卡格列净或司美格鲁肽治疗的长期经济性进行评价。方法从我国卫生体系角度出发,构建Markov模型,基于SUSTAIN 8研究数据模拟我国T2DM患者在二甲双胍基础上联用卡格列净或司美格鲁肽治疗30年的长期成本和效用,并以2024年我国人均国内生产总值(GDP)的1倍作为意愿支付(WTP)阈值计算增量成本-效果比(ICER)和增量净货币收益(INMB)。通过单因素敏感性分析、概率敏感性分析以及情境分析确认基础分析结论的稳定性。结果与卡格列净+二甲双胍方案相比,司美格鲁肽+二甲双胍方案的ICER为260485.67元/质量调整生命年(QALY),大于本研究设定的WTP阈值(95749元/QALY),INMB为-61576.24元,卡格列净+二甲双胍方案更具经济性优势。司美格鲁肽+二甲双胍方案组糖尿病无并发症治疗成本对INMB的影响最大,但参数在选定范围内的变动不会驱动结果发生逆转。随着WTP阈值的增加,司美格鲁肽+二甲双胍方案在经济性上的可接受概率呈上升趋势。在当前WTP阈值下,司美格鲁肽的年成本需下降42.95%,司美格鲁肽+二甲双胍方案才能成为更具经济性优势的方案。结论从中国卫生体系角度出发,对于单用二甲双胍血糖控制不佳的T2DM患者,卡格列净+二甲双胍方案相较于司美格鲁肽+二甲双胍方案更具经济性优势。OBJECTIVE To evaluate the long-term cost-effectiveness of canagliflozin or semaglutide in patients with type 2 diabetes mellitus(T2DM)poorly controlled with metformin.METHODS Based on the perspective of China’s health system,a Markov model was used to calculate the long-term costs and utilities of canagliflozin or semaglutide combined with metformin for T2DM patients in China for 30 years based on the data from SUSTAIN 8 study.The incremental cost-effectiveness ratio(ICER)and incremental net monetary benefit(INMB)were calculated using one time the 2024 per capita gross domestic product(GDP)as the willingness-to-pay(WTP)threshold.One-way sensitivity analysis,probability sensitivity analysis and scenario analysis were conducted to confirm the stability of the conclusions.RESULTS Compared with canagliflozin+metformin,ICER of semaglutide combined with metformin was 260485.67 yuan/quality-adjusted life year(QALY),which was higher than the WTP threshold set in this study(95749 yuan/QALY),and the corresponding INMB was-61576.24 yuan,indicating that the canagliflozin+metformin regimen was more cost-effective.The cost of diabetes without complications treatment in the semaglutide+metformin group had the greatest influence on INMB,but changes in parameters within the selected range did not drive decision reversal.With the increasing of WTP threshold,the economic acceptability of semaglutide+metformin regimen increased.Under the current WTP threshold,the annual cost of semaglutide should be reduced by 42.95%to make the semaglutide+metformin regimen more costeffective.CONCLUSIONS From the perspective of China’s health system,canagliflozin+metformin is more costeffective than semaglutide+metformin for T2DM patients with poor glycemic control with metformin alone.

关 键 词：司美格鲁肽 卡格列净 二甲双胍 2型糖尿病 血糖控制不佳 MARKOV模型 药物经济学 队列模拟 

分 类 号：R956[医药卫生—药学]