替尔泊肽和司美格鲁肽治疗中国2型糖尿病患者的成本-效果分析

Cost-effectiveness analysis of tirzepatide and semaglutide for treatment of patients with type 2 diabetes mellitus in China

摘要

目的: 评价不同剂量的替尔泊肽和司美格鲁肽治疗中国2型糖尿病（T2DM）患者的经济性,为医保决策提供参考。方法: 采用 Markov 模型模拟4种治疗方案的长期健康产出和经济效益。以质量调整生命年（QALYs）为健康产出指标,以3倍我国2024年人均国内生产总值作为意愿支付阈值（WTP）,模拟患者使用4种治疗方案治疗30年后的健康产出和医疗成本,以增量成本-效果比（ICER）作为评价指标,评价4种治疗方案的经济性,关键假设通过单因素及概率敏感性分析验证,确保模型稳健性。结果: 与 1 mg 司美格鲁肽治疗方案相比, 5、10、15 mg 替尔泊肽治疗方案的增量成本分别为 333108.30、699163.50、968283.70元;增量效果分别为0.0631≤0.1405、0.1655 QALYs;ICER 分别为5278151.00≤4977303.00≤5852089.70元 ∙ QALY^-1。当 WTP 为 287247 元 ∙ QALY^-1 时,5、10、15 mg 替尔泊肽治疗方案都不具有经济性。敏感性分析结果显示,基础分析结果较为稳健。情境分析结果显示,在 287247 元 ∙ QALY ^-1 的 WTP 下, 5、10、15 mg 替尔泊肽单位剂量的价格分别降低 68.4％、79.6％、77.3％时,替尔泊肽与司美格鲁肽相比具有经济性的概率相当。结论: 基于 SURPASS-2 试验,在当前情境下,对于二甲双胍单药治疗血糖控制不佳的 T2DM 患者,与1 mg 司美格鲁肽治疗方案相比, 5、10、15 mg 替尔泊肽治疗方案在当前价格下具有经济性的概率较低,适当降价后可成为更安全有效且经济的治疗方案。

Abstract

Objective: To evaluate the economy of different doses of tirzepatide and semaglutide in the treatment of adult patients with type 2 diabetes mellitus(T2DM)in China,thus to provide a reference for medical insurance decision-making. Methods: The Markov model was adopted to simulate the long-term health outputs and economic benefits of the four treatment regimens.Taking quality-adjusted life years(QALYs)as the indicator of health output and three times China's per capita GDP in 2024 as the willingness to pay threshold(WTP),the health output and medical costs of patients after 30 years of treatment with four treatment regimens were simulated.++++The incremental cost-effectiveness ratio（ICER）was used as the evaluation index to evaluate the economy of the four treatment regimens.The key assumptions were verified through univariate and probabilistic sensitivity analyses to ensure the robustness of the model. Results: Compared with the 1 mg semaglutide treatment regimen,the incremental costs of the 5,10, 15 mg tirzepatide treatment regimens were 333 108.30,699163.50, 968283.70 yuan,respectively; the incremental effects were 0.0631,0.1405,and 0.1655 QALYs respectively;the ICERs were 5278 151.00, 4977303.00,and 5852089.70 yuan∙QALY^-1,respectively.When the WTP was 287247 yuan ∙ QALY^-1,the 5,10, 15 mg tirzepatide treatment regimens were not economically viable.The results of the sensitivity analysis showed that the results of the basic analysis were relatively robust.The results of the situation analysis showed that at the WTP of 287247 yuan ∙ QALY ^-1,when the unit prices of 5,10, 15 mg tirzepatide decrease by 68.4％, 79.6％,and 77.3％respectively,the probabilities of economic viability of tirzepatide compared with semaglutide were comparable. Conclusion: For T2DM patients with poor blood glucose control treated with metformin monotherapy, compared with the 1 mg semaglutide regimen,the 5,10, 15 mg tirzepatide treatment regimens have a lower probability of being economically viable at the current price.Appropriate price reduction can make tirzepatide become a safer, more effective,and economical treatment regimen.

关键词

替尔泊肽 / 司美格鲁肽 / 2型糖尿病 / Markov 模型 / 成本-效果分析 / 药物经济学

Key words

tirzepatide / semaglutide / type 2 diabetes / Markov model / cost-effectiveness analysis / pharmacoeconomics

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基金资助

河北省自然科学基金资助项目（H2021206407）