俄罗斯联邦成年2型糖尿病合并糖尿病肾病患者使用沙列净预算影响的长期分析

Q3 Medicine
N. Avxentyev, Y. Makarova
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引用次数: 0

摘要

背景。糖尿病肾病(Diabetic nephropathy, DN)是糖尿病患者的一种特异性肾脏病变,可发展为终末期肾病,需要肾脏替代治疗(透析或移植)。加格列净是一种钠-葡萄糖共转运蛋白2 (SGLT2)抑制剂,具有保护肾的作用。根据已发表的数据,canagliflozin在2型糖尿病(DM2)和DN患者中的应用可以将透析治疗推迟近13年。目的:从俄罗斯联邦组成实体的角度,对卡格列净对成年DM2和DN患者的预算影响进行长期分析。材料和方法。一组比较卡格列净为安慰剂(无肾保护药物治疗)。作者提出了接受卡格列净(100mg口服,每日,长期)或安慰剂组患者DN进展的数学模型。该模型基于CREDENCE研究数据的外推。该模型用于分析每位患者终身药物治疗和透析的直接成本。来自联邦登记册的糖尿病成年患者数量和这些患者中DN患病率的流行病学数据用于评估目标人群的规模。根据糖尿病患者的临床推荐和医疗护理标准,以及2021年SGLT2抑制剂和胰高血糖素样肽-1受体激动剂的实际国家采购数据,我们评估了目前未接受肾保护治疗但必须按标准给予卡格列净的DM2+DN患者的份额。在该人群中,我们确定了肾小球滤过率在30-90 ml/min/1.73 m2之间的患者,这为目标人群与CREDENCE临床研究中纳入的患者提供了可比性。每位接受canagliflozin治疗的患者的直接医疗费用为678 108卢布,比未接受肾保护药物治疗的患者(1,437 347卢布)低52.8%(759,239卢布)。因此,考虑到建模期和目前的实践,DM2+DN患者药物治疗的预算费用为998.2亿卢布,而拟议的做法为470.9亿卢布(预算费用差异为527.3亿卢布,或52.8%)。与未接受肾保护药物治疗的患者相比,在开始治疗11年后,接受卡格列净的患者在区域卫生保健系统的累积费用较低。扩大canagliflozin在DM2+DN患者治疗中的应用,由于免透析期的延长,从长远来看可以降低预算成本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term analysis of сanagliflozin budget impact in adult patients with type 2 diabetes mellitus and diabetic nephropathy in the Russian Federation
Background. Diabetic nephropathy (DN) is a specific kidney lesion in patients with diabetes mellitus, which leads to the development of endstage kidney disease and requires substitutive renal therapy (dialysis or transplantation). Canagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor, which exerts a renoprotective effect. According to the published data, the application of canagliflozin in patients with type 2 diabetes mellitus (DM2) and DN could postpone dialysis therapy for almost 13 years.Objective: to perform a long-term analysis of canagliflozin budget impact in adult patients with DM2 and DN from the point of view of the constituent entities of the Russian Federation.Material and methods. A group of comparison for canagliflozin was placebo (no renoprotective pharmacotherapy). The authors proposed a mathematical model for DN progression in groups of patients who received canagliflozin (100 mg orally, daily, long-term) or placebo. The model was based on the extrapolation of the CREDENCE study data. The model was used for the analysis of the direct costs on the lifetime pharmacotherapy and dialysis per one patient. Epidemiologic data from the federal register on the number of adult patients with DM and DN prevalence among these patients were used to evaluate the size of the target population. Based on the clinical recommendations and the medical care standards for patients with DM and the data on the actual state procurement of SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists in 2021, we evaluated the share of patients with DM2+DN who currently do not receive renoprotective therapy but who must be supplied with canagliflozin according to the standards. Among this population, we determined the patients with the glomerular filtration rate within 30–90 ml/min/1.73 m2, which provides the comparability of the target population with patients included in CREDENCE clinical study.Results. Direct medical costs per one patient receiving canagliflozin therapy were 678 108 rubles, which was 52.8% (759,239 rubles) lower than without renoprotective pharmacotherapy (1,437,347 rubles). As a result, considering the modeling period and current practice, the budget costs for pharmacotherapy of patients with DM2+DN were 99.82 billion rubles, in comparison with the proposed practice, which was 47.09 billion rubles (difference in budget costs is 52.73 billion rubles, or 52.8%). The accumulated costs of the regional health care system were lower in patients receiving canagliflozin in comparison with patients without renoprotective pharmacotherapy 11 years after the beginning of treatment.Conclusion. The expansion of canagliflozin application in the therapy for patients with DM2+DN leads to the budget cost cuts in the long run due to the extension of the dialysis-free period.
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来源期刊
Farmakoekonomika
Farmakoekonomika Medicine-Health Policy
CiteScore
1.70
自引率
0.00%
发文量
43
审稿时长
8 weeks
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