替尔泊肽治疗超重/肥胖的系统评价与药物经济学分析

Systematic review and pharmacoeconomic evaluation of tirzepatide for the treatment of overweight/obesity

摘要

目的: 评估替尔泊肽治疗超重/肥胖的有效性、安全性和经济性。方法: 采用网状Meta分析(network Meta-analysis,NMA)综合比较替尔泊肽与司美格鲁肽治疗超重/肥胖的疗效,并采用成本效果分析进行药物经济学评价。结果: 系统检索14项随机对照试验。NMA显示,疗效上替尔泊肽组的减重幅度[均数差(mean difference,MD)=-6.50%,95%CI:-8.13%~-4.87%]、腰围缩减(MD=-5.40%)及体质量降幅＞15%的达标率[风险比(relative risk,RR)=1.28均显著优于司美格鲁肽组(P<0.001)],但血糖控制无统计学差异。安全性方面,两组胃肠道不良事件总体发生率相近,替尔泊肽的呕吐风险更低(RR=0.70,95%CI:0.55~0.89)。药物经济学结果显示,增量成本效果比(incremental cost-effectiveness ratio,ICER)值为87 714.55元,远低于意愿支付阈值,说明替尔泊肽相比于司美格鲁肽更具有经济性。结论: 替尔泊肽的减重疗效和经济性均显著优于司美格鲁肽,未来需进一步验证其长期安全性。

Abstract

Objective: To evaluate the efficacy, safety, and economics of tirzepatide in the treatment of overweight/obesity. Methods: A comprehensive comparison of the efficacy of tirzepatide and semaglutide in the treatment of overweight/obesity was performed using reticulated Meta-analysis (NMA), and cost-effectiveness analysis was used for pharmacoeconomic evaluation. Results: A total of 14 randomized controlled trials were searched. The NMA showed that for efficacy, the tirzepatide group was significantly better than the simelglutide group in terms of weight loss (MD=-6.50%, 95%CI: -8.13% to -4.87%), waist circumference reduction (MD=-5.40%), and the attainment rate of >15% weight loss (RR=1.28) (P<0.001), but the glycemic control was not statistically different. For safety, the overall incidence of gastrointestinal adverse events was similar in both groups, with a lower risk of vomiting with telbivudine (RR=0.70, 95%CI: 0.55~0.89). For the pharmacoeconomics, the ICER value of 87 714.55 yuan was well below the willingness-to-pay threshold, suggesting that tirzepatide was more cost-effective compared with semaglutide. Conclusion: The weight loss efficacy and economy of tirzepatide are significantly better than those of semaglutide, and its long-term safety needs to be further verified in the future.    

关键词

肥胖/超重 / 替尔泊肽 / 司美格鲁肽 / 网状Meta分析 / 系统评价 / 药物经济学评价

Key words

obesity/overweight / tirzepatide / semaglutide / network Meta-analysis / systematic review / pharmacoeconomic evaluation

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基金资助

辽宁省研究生教育教学改革研究资助项目(LNYJG2024253);辽宁省教育科学“十四五”规划2024年度课题立项名单项目(JG24DB452)