Cost-Effectiveness Analysis of Pharmacological Treatment With Insulin and Insulin Analogs for Type 1 and Type 2 Diabetes Mellitus in Colombia

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES
Luis Esteban Orozco Ramirez MSc , Diego Fernando Ávila Ibáñez MSc , Christian Camilo Anzola Morales MSc , Luz Karime Osorio Arango MSc , Merideidy Plazas MSc , Ivan Darío Escobar END
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Abstract

Objectives

This study aimed to estimate the cost-effectiveness relationship of insulins and insulin analogs in diabetes mellitus type 1 (DM1) and 2 (DM2), from the perspective of the Colombian health system.

Methods

A short-term decision tree model (SM) was built, the outcome of which was severe/nocturnal hypoglycemia, and a long-term Markov model for quality-adjusted life-years. The probabilities were calculated through a literature review of effectiveness and safety. The costs are estimated from official databases. Deterministic and probabilistic sensitivity analyses were performed.

Results

For DM1, in prandial insulins, and for both models, the cost-effective interventions (CEIs) are aspartate and lispro. In basal insulins, the CEIs are NPH and glargine U-100 in both models. In the comparison of detemir and NPH, detemir generates lower nocturnal hypoglycemia and higher quality-adjusted life-years; however, in the long-term Markov model, the incremental cost-effectiveness ratio exceeds the threshold. For DM2, in the prandial insulin, and for both models, aspartate is a CEI and the glargine U-300 is also a CEI in the SM. In basal insulin, the CEIs are glargine U-100 and detemir (for nocturnal hypoglycemia) in both models and glargine U-300 is also a CEI in the SM. Finally, in the group of combinations, iGlarLixi is dominant over IDegLira.

Conclusions

The results favor the use of analog insulins over human insulins, the former reducing the possibility of acute events and chronic complications to a greater extent.
胰岛素及胰岛素类似物治疗哥伦比亚1型和2型糖尿病的成本-效果分析
目的从哥伦比亚卫生系统的角度,评估胰岛素和胰岛素类似物治疗1型糖尿病(DM1)和2型糖尿病(DM2)的成本-效果关系。方法建立以重度/夜间低血糖为预后指标的短期决策树模型(SM)和以质量调整生命年为预后指标的长期马尔可夫模型。通过对有效性和安全性的文献回顾来计算概率。费用是根据官方数据库估计的。进行了确定性和概率敏感性分析。结果对于DM1,在膳食胰岛素中,对于这两种模型,具有成本效益的干预措施(CEIs)是天冬氨酸和利斯普罗。在基础胰岛素方面,两种模型的cei均为NPH和甘精氨酸U-100。在替特弥与NPH的比较中,替特弥产生较低的夜间低血糖和较高的质量调整生命年;然而,在长期马尔可夫模型中,增量成本-效果比超过阈值。对于DM2,在膳食胰岛素中,对于两种模型,天冬氨酸是CEI,甘精氨酸U-300也是SM中的CEI。在基础胰岛素中,两种模型的CEI均为甘精U-100和detemir(用于夜间低血糖),而在SM中,甘精U-300也是CEI。最后,在组合组中,iGlarLixi优于IDegLira。结论与人胰岛素相比,模拟胰岛素更有利于减少急性事件和慢性并发症的发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Value in health regional issues
Value in health regional issues Pharmacology, Toxicology and Pharmaceutics-Pharmacology, Toxicology and Pharmaceutics (miscellaneous)
CiteScore
2.60
自引率
5.00%
发文量
127
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