{"title":"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","authors":"Kah Suan Chong, Chun-Ting Yang, Chi-Chuan Wang, Huang-Tz Ou, Shihchen Kuo","doi":"10.1007/s40273-025-01536-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 m<sup>2</sup>: $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/m<sup>2</sup>: $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 $1267 for those aged ≥ 65 years.</p><p><strong>Conclusions: </strong>Our analysis suggests that adopting SGLT2is over DPP4is for T2D is highly cost-effective across patient subgroups, particularly for the elderly and patients with mild renal impairment.</p>","PeriodicalId":19807,"journal":{"name":"PharmacoEconomics","volume":" ","pages":""},"PeriodicalIF":4.6000,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Heterogeneity in Economic Value of SGLT2is for Type 2 Diabetes: Subgroup Modeling Cost-Effectiveness Analyses.\",\"authors\":\"Kah Suan Chong, Chun-Ting Yang, Chi-Chuan Wang, Huang-Tz Ou, Shihchen Kuo\",\"doi\":\"10.1007/s40273-025-01536-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objective: </strong>Although heterogeneous treatment effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) have been revealed, the heterogeneous economic value of SGLT2is in real-world type 2 diabetes (T2D) populations with diverse clinical characteristics remains unclear. We conducted subgroup cost-effectiveness analyses of SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP4is) among patients with T2D.</p><p><strong>Methods: </strong>A multi-state transition model was used to estimate the incremental cost-effectiveness ratios (ICERs, in US$ 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.</p><p><strong>Results: </strong>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 m<sup>2</sup>: $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/m<sup>2</sup>: $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 $1267 for those aged ≥ 65 years.</p><p><strong>Conclusions: </strong>Our analysis suggests that adopting SGLT2is over DPP4is for T2D is highly cost-effective across patient subgroups, particularly for the elderly and patients with mild renal impairment.</p>\",\"PeriodicalId\":19807,\"journal\":{\"name\":\"PharmacoEconomics\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-09-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"PharmacoEconomics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s40273-025-01536-6\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ECONOMICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"PharmacoEconomics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s40273-025-01536-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ECONOMICS","Score":null,"Total":0}
Heterogeneity in Economic Value of SGLT2is for Type 2 Diabetes: Subgroup Modeling Cost-Effectiveness Analyses.
Background and objective: Although heterogeneous treatment effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) have been revealed, the heterogeneous economic value of SGLT2is in real-world type 2 diabetes (T2D) populations with diverse clinical characteristics remains unclear. We conducted subgroup cost-effectiveness analyses of SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP4is) among patients with T2D.
Methods: A multi-state transition model was used to estimate the incremental cost-effectiveness ratios (ICERs, in US$ 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.
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
