钠-葡萄糖共转运蛋白2抑制剂治疗心力衰竭患者：成本-效用研究的系统回顾和荟萃分析

IF 3.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics Pub Date : 2025-03-01 DOI:10.1016/j.archger.2025.105809

Xinyue Zhang , Yanxia Zhang , Jiayu Wang , Zhijia Tang

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引用次数: 0

摘要

钠-葡萄糖共转运蛋白-2抑制剂（SGLT-2i）在降低心血管死亡率和心力衰竭（HF）住院方面显示出希望，心力衰竭是一个重大的全球健康问题。本研究旨在通过成本效用研究的系统回顾和荟萃分析来评估SGLT-2i在HF患者中的增量净收益（INB）。方法：我们检索了5个数据库，从建立到2024年8月30日，选取了报告SGLT-2i联合标准三联治疗与单独标准三联治疗在HF患者中的成本-效果和成本-效用分析的经济演变研究。作为主要结果的国际比价是根据2022年美元购买力平价调整后的货币单位计算的。本综述纳入46项研究，其中41项研究（55项比较）纳入meta分析。从医疗保健系统的角度来看，与单独的标准三联疗法相比，添加SGLT2is具有成本效益(INB， 4042.08美元；95% CI, 1758.70- 6325.46美元)和付费视角(INB， 12972.84美元；95% ci, 4711.5- 21,234.22美元)。然而，亚组分析显示，从医疗保健系统的角度来看，保留射血分数（HFpEF）的HF患者的经济效益不显著(INB, - 639.32美元；95% CI, - 1850.09美元- 571.44美元)和付款人视角(INB， 3611.07美元；95% ci, - 208.49美元- 7430.64美元)。此外，从付款人的角度来看，来自低收入和中等收入国家的HF患者没有显示出显著的经济效益(国际收支，55,645.70美元；95% ci, $51,000.00-$160,000 0.00)。结论从医疗保健系统和付款人的角度来看，与传统的标准三联疗法相比，添加SGLT-2i具有成本效益。然而，在高强度食品和中低收入国家，其经济效益是有限的。需要进一步的研究来从更广泛的社会角度探讨成本效益。

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Sodium-glucose cotransporter 2 inhibitors in the treatment of heart failure patients: A systematic review and meta-analysis of cost-utility studies

Aims

Sodium–glucose cotransporter-2 inhibitors (SGLT-2i) have shown promise in reducing cardiovascular mortality and hospitalization due to heart failure (HF), a significant global health issue. This study aims to evaluate the incremental net benefit (INB) of SGLT-2i in HF patients through a systematic review and meta-analysis of cost-utility studies.

Methods

We searched five databases from their inception until Aug 30, 2024, economic evolution studies reporting cost-effectiveness and cost-utility analyses comparing SGLT-2i combined with standard triple-therapy versus standard triple-therapy alone in HF patients were selected. INB as the primary outcome was calculated in monetary units adjusted for purchasing power parity in 2022 US dollars.

Results

This review included 46 studies, with 41 studies (55 comparisons) pooled into meta-analysis. Adding SGLT2is was cost-effective compared to standard triple-therapy alone, from both healthcare system perspective (INB, $4042.08; 95 % CI, $1758.70-$6325.46) and payer perspective (INB, $12,972.84; 95 % CI, $4711.5-$21,234.22). However, subgroup analyses showed non-significant economic benefit in HF patients with preserved ejection fraction (HFpEF) both from the healthcare system perspective (INB, -$639.32; 95 % CI, -$1850.09-$571.44) and the payer perspective (INB, $3611.07; 95 % CI, -$208.49-$7430.64). Additionally, HF patients from low- and middle-income countries did not show significant economic benefit from the payer perspective (INB, $55,645.70; 95 % CI, -$51,000.00-$160,000.00).

Conclusions

The findings suggest that adding SGLT-2i is cost-effective compared to conventional standard triple-therapy alone, from both healthcare system and payer perspectives. Nevertheless, the economic benefits are limited in HFpEF and those from low- and middle-income countries. Further research is needed to explore the cost-effectiveness from a broader societal perspective.

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来源期刊

Archives of gerontology and geriatrics 医学-老年医学

CiteScore

7.30

自引率

5.00%

发文量

198

审稿时长

16 days

期刊介绍： Archives of Gerontology and Geriatrics provides a medium for the publication of papers from the fields of experimental gerontology and clinical and social geriatrics. The principal aim of the journal is to facilitate the exchange of information between specialists in these three fields of gerontological research. Experimental papers dealing with the basic mechanisms of aging at molecular, cellular, tissue or organ levels will be published. Clinical papers will be accepted if they provide sufficiently new information or are of fundamental importance for the knowledge of human aging. Purely descriptive clinical papers will be accepted only if the results permit further interpretation. Papers dealing with anti-aging pharmacological preparations in humans are welcome. Papers on the social aspects of geriatrics will be accepted if they are of general interest regarding the epidemiology of aging and the efficiency and working methods of the social organizations for the health care of the elderly.