The Economic Evaluation For Adverse Events Of Insulin Glargine And GLP-1 Receptor Agonist Using Markov Model

Objective:To conduct long-term economic evaluation for the major adverse events of insulin glargine and GLP-1 receptor agonists based on the efficacy by Markov model,so as to provide a reference for drug selection of type 2 diabetes patients in China and improve the quality of life of diabetes patients within the affordable economic level.Methods:1.The therapeutic effects and adverse events of insulin glargine and glp-1 receptor agonist were compared by literature review.Based on the therapeutic effect,the major adverse events included in Markov model were determined.2.According to the main adverse events of the two types of drugs and its outcome,the Markov state was determined and the Markov state transition model was established.By consulting literatures and national statistical data,the transfer probabilities,costs and utility values of insulin Glargine(Glar),Liraglutide 1.2 mg(Lira 1.2 mg),Liraglutide 1.8mg(Lira 1.8 mg),Exenatide 10 μg(Exe 10 μg),Exenatide 5 μg(Exe 5 μg)and Benaglutide(Bena)between states were obtained.3.Using TreeAge Pro 2011 software,the outcomes of six intervention measures,including Glar,Lira 1.2 mg,Lira 1.8 mg,Exe 10 μg,Exe 5 μg and Bena,in the three health states of diabetes without adverse events,diabetes with adverse events and death,were simulated respectively.The cycle time was set at 1 year and the simulation time was 20 years.4.A roll back analysis,half-cycle correction,cohort simulation,incremental cost-effectiveness analysis and sensitivity analysis were conducted on Markov model from the perspective of the whole society.The cost and Quanlity adjusted life years(QALYs)of six interventions for 20 years were obtained,and incremental cost-effectiveness ratio(ICER)was calculated.Costs and effects were discounted using a5% discount rate,and one way sensitivity analysis and probabilistic sensitivity analysis were performed for uncertainties.Results:1.The results of baseline roll back analysis showed that the average cost per capita of 20 years for Glar,lira 1.2 mg,lira 1.8 mg,Exe 10 μg,Exe 5 μg and Bena was 70948.70,93939.31,138108.92,151944.41,163404.57 and 225612.16 yuan,respectively,with 5.14,6.84,7.16,6.05,7.06 and 7.89 QALYs,respectively.The cost-effectiveness ratio was 13803.25,13733.82,19288.96,25114.78,23145.12 and28594.70 yuan /QALY,respectively.2.The results of Markov cohort simulation showed that after 20 cycles of the model,97.16%,88.28%,85.43%,93.96%,86.33%,77.44% died in the patient of Glar,Lira 1.2mg,Lira 1.8 mg,Exe 10 μg,Exe 5 μg and Bena,respectively.Adverse events occurred at 2.37%,5.37%,5.75%,3.90%,5.65% and 5.94%,respectively.3.The results of the incremental cost effect analysis showed that compared with Glar,the ICER of Lira 1.2 mg,Lira 1.8 mg,Exe 10 μg,Exe 5 μg and Bena were: 13523.89,33247.63,89006.27,48154.10 and 56241.26,respectively.Compared with Lira,Exe 10 μg and Exe 5μg have high cost but low effect,both of which are disadvantaged solutions.The ICER of lira 1.2 mg,lira 1.8 mg and Bena were all lower than the threshold(59,660 yuan),indicating that Lira 1.2 mg,Lira 1.8 mg and Bena had cost-effectiveness advantages.4.The sensitivity analysis results showed that changing the uncertainty factors within the set range,the results were basically consistent,indicating the robustness of theresearch results.The results of sensitivity analysis on the duration showed that,the longer the time,the smaller the ICER of Lira and Bena,indicating that the economy of Lira and Bena could be better reflected after long-term drug use.Conclusion:Compared with Glar,All five GLP-1 receptor agonist interventions had cost-effectiveness advantages.Compared with Lira,Exe is a disadvantage.Considering that Lira 1.2mg,Lira 1.8mg and Bena have cost-effective advantages,and Lira 1.2 mg is more economical.It is suggested that treatment type 2 diabetes with liraglutide allows patients to achieve a better quality of life and prolong survival in a certain economic level.