SGLT2i治疗糖尿病肾病的临床疗效和成本效益:一项基于人群的大型研究

IF 7.4 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Hsuan-Hui Wang , Yi-Wen Chiu , Cheng-Yin Chung , Yu-Mei Liao , Yung-Heng Lee , Han-Ming Kuo , Hon-Yi Shi
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引用次数: 0

摘要

目的评价SGLT2i在糖尿病肾病常规治疗中的临床疗效和成本-效果。方法对2017 - 2023年台湾3家医疗中心诊断为糖尿病肾病的患者进行回顾性队列研究。处理加权逆概率(IPTW)最小化选择偏差。临床结果的最长随访时间为5.9年,中位随访时间为2.79年。一个具有10年视界、1年周期和3%贴现率的马尔可夫模型从医疗保健支付者的角度评估了成本效益。结果与非sglt2i治疗相比,使用ssglt2i与估计肾小球滤过率(eGFR)和血红蛋白A1c (HbA1c)的改善有统计学意义(p < 0.05)。SGLT2i组每位患者的平均总成本为38,072美元,非SGLT2i组为26,567美元。质量调整生命年(QALYs)的增量增量为0.70,导致成本效益比(ICER)的增量为16,435.71美元/QALYs。这一价值远低于既定的支付意愿阈值32,756美元,表明具有良好的成本效益。结论尽管SGLT2i具有良好的临床疗效和成本效益,但其用于糖尿病肾病的国家健康保险报销仍有待解决,并且泌尿生殖系统感染的可能性需要持续的临床警惕。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical efficacy and cost effectiveness of SGLT2i in diabetic nephropathy: a large population-based study

Objective

To evaluate the clinical efficacy and cost-effectiveness of SGLT2i versus non-use in routine care for diabetic nephropathy.

Methods

A retrospective cohort study was conducted analyzing patients diagnosed with diabetic kidney disease at three medical centers in Taiwan between 2017 and 2023. Inverse probability of treatment weighting (IPTW) minimized selection bias. The maximum follow-up period for clinical outcomes was 5.9 years, with a median duration of 2.79 years. A Markov model with a 10-year horizon, 1-year cycle, and 3 % discount rate assessed cost-effectiveness from the healthcare payer perspective.

Results

SGLT2i use was associated with statistically significant improvements in estimated glomerular filtration rate (eGFR) and hemoglobin A1c (HbA1c) compared to non-SGLT2i treatment (p < 0.05). Mean total cost per patient was $38,072 for the SGLT2i group and $26,567 for the non-SGLT2i group. The incremental quality-adjusted life years (QALYs) gain was 0.70, resulting in an incremental cost-effectiveness ratio (ICER) of $16,435.71/QALYs. This value was well below the established willingness-to-pay (WTP) threshold of $32,756, indicating favorable cost-effectiveness.

Conclusions

Although SGLT2i demonstrate favorable clinical efficacy and cost-effectiveness, National Health Insurance reimbursement for their use in diabetic nephropathy remains pending, and the potential for genitourinary infections necessitates ongoing clinical vigilance.
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来源期刊
Diabetes research and clinical practice
Diabetes research and clinical practice 医学-内分泌学与代谢
CiteScore
10.30
自引率
3.90%
发文量
862
审稿时长
32 days
期刊介绍: Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.
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