北京大学公共卫生学院知识库

Objectives: To evaluate the long-term cost-effectiveness of switching from insulin glargine (IGla) to insulin detemir (IDet) in patients with type 2 diabetes in the setting of Chinese secondary and tertiary hospitals. Methods: A published and validated computer simulation model of diabetes (the Center for Outcomes Research model) was used to make the long-term (30 years) projection of health economic outcomes. Patient demographic information and clinical end points were derived from a subgroup analysis of the Predictable Results and Experience in Diabetes through Intensification and Control to Target: an International Variability Evaluation (PREDICTIVE) study. Baseline risk factors and racial characteristic data were obtained from Chinese cohort studies. The diabetes management and complications costs were obtained from Chinese published data and adjusted to 2010 values by using the Chinese consumer price index. An annual discounting rate of 3% was used for both health and cost outcomes, and one-way sensitivities analysis was performed, which illustrated that the results were robust. Results: Conversion to IDet from IGla was projected to improve patient life expectancy by 0.06 year and 0.48 quality-adjusted life-years. Drug costs and management costs of diabetes mellitus were increased by US$368 (US$17,466 vs. US$17,097) and US$31 (US$5464 vs. US$5433), respectively. However, the costs of complications, including cerebrovascular disease, renal complications, ulcer/amputation/neuropathy, eye complications, and hypoglycemia events, were reduced by US$ 819 (US$21,294 vs. US$22,114), resulting in a total direct medical cost saving of US$420 when converting to IDet. Conclusions: Conversion to IDet from an IGla regimen improved life expectancy and was a cost-saving treatment approach in a Chinese setting.