Economic Evaluation Of Oral Drugs For Type 2 Diabetes Mellitus

Research was to compare the short-term cost-effectiveness and long-term cost-utility of domestic versus imported acarbose for type 2 diabetes.To provide reference for rational use of drugs for clinical and methodology for pharmacoeconomics evaluation;to provide scientific decision basis for solving the high prices of drugs.A retrospective analysis was made on 64 patients using metformin,pioglitazone and acarbose combination therapy from March 2015 to December 2015,32 cases in group A(domestic)and 32 cases in group B(imported).Observated and calculated the cost of drugs and clinical effect for 1 month,compared the short-term cost-effectiveness,and taken sensitivity analysis for the cost of both kinds of acarbose.Then used the Markov model to evaluate long-term cost-utility of acarbose for type 2 diabetes with the baseline value of short-term clinical data,drug cost from clinical;other cost discounted through literature;utility values taken from literature;transition probability calculated from baseline data UKPDS by assumptions and literature review.In the short-term economic research,both groups of patients had a significant decline in the average blood glucose and HbA1 c after treatment,group A had an effective rate 65.63% versus group B 71.87%,group B was slightly better than group A in curative effect,but there was no significant difference.Lower fasting glucose 1 unit,group A need cost 175.19 yuan,and group B need 149.77 yuan;reduce postprandial two-hour blood glucose 1 unit,group A need cost 64.15 yuan,and group B need 66.97 yuan;lower HbA1 c 1 unit,group A need cost 327.30 yuan,and group B need 288.42 yuan.From the perspective of fasting glucose and HbA1 c,imported acarbose held advantage,but from the perspective of postprandial two-hour blood glucose,domestic acarbose was slightly better.Drug price had influence on the result of the research.With HbA1 c as index,in order to make domestic acarbose better than imported in cost-effectiveness,the drug price should be controlled in less than 1.02 yuan/piece for domestic acarbose.In the long-term economic research,simulated diabetes for 30 years of disease progression,the cost-utility of roll back analysis was 18345.95 yuan/QALY for group A and 17856.46 yuan/QALY for group B,the ICER is-14562.46 yuan/QALY;the cumulative cost of Markov cohort simulation was 315917.19 yuan for group A and 312130.94 yuan for group B,the cumulative utility was 17.22 QALYs for group A and 17.48 QALYs for group B.The ICER value was-14562.46 yuan/QALY;Monte Carol simulation calculated treatment of 10000 patients with diabetes,more than 60% of patients had the cost nearly 250000 yuan for group A versus more than 70% of patients nearly 300000 yuan for group B,QALY gain mainly distributed in 17 to 18 years in both groups.The ICER value was-17813.83 yuan/QALY.Compared with group B,ICER < 0,? C > 0,? U < 0 was always formed,so imported acarbose held advantage.Results in diabetes were sensitive to utility values and drug price,especially the utility for patients with type 2 diabetes mellitus.