Pharmacoeconomic Evaluation On Dapagliflozin In Patients With Type 2 Diabetes And Cardiovascular Disease

Part 1: Short-term pharmacoeconomic evaluation of dapagliflozin in the treatment of type 2 diabetes patients with cardiovascular diseaseObjective: To evaluate the short-term cost-effectiveness of dapagliflozin plus metformin in the treatment of type 2 diabetes mellitus(T2DM)patients with cardiovascular disease,so as to provide reference for the rational selection of hypoglycemic drugs for comorbid patients.Methods: Retrospective data of a Third-grade Class-A hospital in Hefei were adopted,129 patients with T2 DM and cardiovascular disease were included in the research,and the difference of baseline between the two groups was balanced through propensity score matching.Based on the societal perspective,the costs of patients for the treatment,the levels of fasting blood glucose(FBG)and 2 hours’ postprandial blood glucose(2h PG)before and after treatment,and clinical efficacy were compared between the two groups.The cost effectiveness ratio(C/E)was calculated,and sensitivity analysis was performed to assess the uncertainty in the results.Results: There was a positive relationship between the cost and effect of the two treatment schemes,the average total cost of dapagliflozin plus metformin treatment was higher than that of metformin treatment((?) 10,495.8 vs.(?) 8,612.1,P = 0.083),the total effective rate of treatment in dapagliflozin plus metformin group was higher than that in the metformin group(77.4% vs.58.5%,P = 0.037).After treatment,the levels of FBG and 2h PG in both groups were lower than those before treatment(all P<0.05).After treatment,the FBG level in the dapagliflozin plus metformin treatment group was lower than metformin group,but there were no significant differences between two groups(P>0.05);the 2h PG level in the dapagliflozin plus metformin treatment group was lower than that in the metformin group,and the difference was statistically significant(P<0.05);no serious adverse reactions were recorded in both groups.The C/E in the metformin group was higher than dapagliflozin plus metformin group(147.22 vs.135.60).The sensitivity analysis showed the base-case results to be robust.Conclusions: Both metformin and dapagliflozin plus metformin in the treatment of type2 diabetes and cardiovascular disease can reduce blood glucose,but dapagliflozin plus metformin has better clinical efficacy,and more advantages in pharmacoeconomic.Part 2: Long-term pharmacoeconomic evaluation of dapagliflozin in the treatment of type 2 diabetes patients and cardiovascular diseasePurpose: To evaluate the long-term cost-effectiveness of dapagliflozin,in addition to standard treatment,for the treatment of adult patients with type 2 diabetes and cardiovascular disease from the Chinese healthcare system perspective,to provide reference for clinical rational drug use and dynamic adjustment of medical insurance catalogue.Methods: A decision-analytic Markov model with one-year cycles was developed to evaluate the long-term health and economic outcomes in patients with T2 DM and cardiovascular disease(CVD)treated with standard treatment and dapagliflozin plus standard treatment.Based on the perspective of the Chinese health system,costs were derived from the real world and published literature,including direct medical costs such as drug costs and treatment costs for cardiovascular complication.Health utilities were sourced from clinical trials and other published literature,using quality adjusted life years(QALYs)as health output indicators.Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty in the results.Results: Compared with standard treatment,dapagliflozin plus standard treatment was predicted to result in an additional 0.25 QALYs(12.26 QALYs vs 12.01 QALYs)at an incremental cost of (?) 33,875.83 per patient.The ICER for dapagliflozin plus standard treatment versus standard treatment was (?) 135,494.41 per QALY gained,which was considered cost-effective in China compared to three times the GDP per capita((?) 242,928).The deterministic and probabilistic sensitivity analyses showed the base-case results to be robust.Conclusions: The study suggests that,from the perspective of the Chinese health system,compared with standard treatment,dapagliflozin as an add-on to standard treatment is a cost-effective option for patients with T2 DM and cardiovascular disease.