Heterogeneity in Economic Value of SGLT2is for Type 2 Diabetes: Subgroup Modeling Cost-Effectiveness Analyses.

IF 4.6 3区医学 Q1 ECONOMICS

PharmacoEconomics Pub Date : 2025-09-12 DOI:10.1007/s40273-025-01536-6

Kah Suan Chong, Chun-Ting Yang, Chi-Chuan Wang, Huang-Tz Ou, Shihchen Kuo

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引用次数: 0

Abstract

Background and objective: Although heterogeneous treatment effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) have been revealed, the heterogeneous economic value of SGLT2is in real-world type 2 diabetes (T2D) populations with diverse clinical characteristics remains unclear. We conducted subgroup cost-effectiveness analyses of SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP4is) among patients with T2D.

Methods: A multi-state transition model was used to estimate the incremental cost-effectiveness ratios (ICERs, in US$ per quality-adjusted life-years [QALYs] gained) and value-based pricing (VBP) among patients with T2D stratified by age, estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), and body mass index (BMI) over 5 years and a Lifetime horizon from a healthcare sector perspective, with both costs and quality-adjusted Life years discounted at 3% annually. Model inputs included treatment effects derived from analysis of individual-level data in Taiwan, and health utilities and costs sourced from published Literature of Taiwanese populations. Deterministic and probabilistic sensitivity analyses across subgroups were performed. All costs were standardized to 2022.

Results: Over 5 years, the ICERs of SGLT2is versus DPP4is were as follows: age subgroups (< 65 versus ≥ 65 years: $26,520 versus $2298/QALY-gained), eGFR subgroups (60 ~ < 90 versus ≥ 90 ml/min/1.73 m²: $7700 versus $12,884/QALY-gained), HbA1c subgroups (< 8.5 versus ≥ 8.5%: $7001 versus $9488/QALY-gained), and BMI subgroups (< 30 versus ≥ 30 kg/m²: $7266 versus $9714/QALY-gained). Over a lifetime, the ICERs became lower, ranging from $2369/QALY-gained for those aged ≥ 65 years to $4239/QALY-gained for those aged < 65 years. Over 5 years, the annual VBP of SGLT2is ranged from $310 for those aged < 65 years to $1267 for those aged ≥ 65 years.

Conclusions: Our analysis suggests that adopting SGLT2is over DPP4is for T2D is highly cost-effective across patient subgroups, particularly for the elderly and patients with mild renal impairment.

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SGLT2is治疗2型糖尿病经济价值的异质性：亚组模型成本-效果分析

背景与目的：虽然钠-葡萄糖共转运蛋白2抑制剂（SGLT2is）的治疗效果具有异质性，但SGLT2is在现实世界中具有不同临床特征的2型糖尿病（T2D）人群中的异质性经济价值尚不清楚。我们在T2D患者中进行了SGLT2is与二肽基肽酶4抑制剂（DPP4is）的亚组成本-效果分析。方法：采用多状态转换模型，从医疗保健部门的角度估计按年龄、估计的肾小球滤过率（eGFR）、糖化血红蛋白（HbA1c）和体重指数（BMI）分层的T2D患者5年的增量成本-效果比（ICERs，以每质量调整生命年[QALYs]获得的美元计算）和基于价值的定价（VBP），成本和质量调整生命年均以每年3%的折扣计算。模型输入包括来自台湾个人层面数据分析的治疗效果，以及来自台湾人口已发表文献的医疗效用和成本。对亚组进行确定性和概率敏感性分析。所有成本都标准化到2022年。结果：5年内，SGLT2is与DPP4is的ICERs如下：年龄亚组（< 65岁vs≥65岁：26,520美元vs 2298美元/ qaly -gain）， eGFR亚组（60 ~ < 90 vs≥90 ml/min/1.73 m2: 7700美元vs 12,884美元/ qaly -gain）， HbA1c亚组（< 8.5 vs≥8.5%:7001 vs 9488美元/ qaly -gain）， BMI亚组（< 30 vs≥30 kg/m2: 7266美元vs 9714美元/ qaly -gain）。在一生中，ICERs变得更低，从≥65岁的人获得的2369美元/ qaly到< 65岁的人获得的4239美元/ qaly不等。5年以上，sglt2i患者的年VBP从< 65岁的310美元到≥65岁的1267美元不等。结论：我们的分析表明，采用SGLT2is而不是DPP4is治疗T2D在患者亚组中具有很高的成本效益，特别是对于老年人和轻度肾功能损害患者。

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

PharmacoEconomics 医学-药学

CiteScore

8.10

自引率

9.10%

发文量

审稿时长

6-12 weeks

期刊介绍： PharmacoEconomics is the benchmark journal for peer-reviewed, authoritative and practical articles on the application of pharmacoeconomics and quality-of-life assessment to optimum drug therapy and health outcomes. An invaluable source of applied pharmacoeconomic original research and educational material for the healthcare decision maker. PharmacoEconomics is dedicated to the clear communication of complex pharmacoeconomic issues related to patient care and drug utilization. PharmacoEconomics offers a range of additional features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand the scientific content and overall implications of the article.