| Background:With the improvement of living standard, diabetes is becoming the 3rd serious non-infectious disease threatening the health of human being following tumor and cardiovascular disease. There are about 246 million diabetic patients in the world till 2007, and the prevalence has been up to 5.9%. Nowadays, there are about 40 million diabetic patients in China, and the prevalence is nearly 4.3%. Along with the high-level economic development, the prevalence is rising obviously. It is predicted that till 2025, there will be about 60 million diabetic patients in China, and the prevalence will rise to 5.6%.About 90-95% diabetic patients suffer from type 2 diabetes mellitus. Besides its latent quality, Type 2 diabetes is a life long disease with high risk of multi-systemic complications, which result in the rising of disability rate and mortality. The increasing prevalence and injury to the organs of diabetes not only cause pain to the patients, but also impose heavy burden on the suffered family and the whole society. It is estimated that, according to the 2000 Global Burden of Diabetes Report, there amounts to 149.3 DALY per 100,000 patients in China. In 2004 the total direct medical expenditure is 57.47 billion, comprising 7.57% of the total health expenditure. Diabetes mellitus has become one of the most important issues of public health, which impacts the health in China and calls on universal public attention.There are multiple alternative approaches to the treatment of diabetes. Besides, there exists three-level prevention network in China. These include screening for the high risk population, diet control and the drug therapy. In the world, there are many studies concerned about the pharmaceutical economics of diabetic drugs, and therefore the policy decision are made based on the results. However, in China, few data exist on the cost-effectiveness of anti-diabetes interventions. And most of the clinical researches reflect the short-term changes of clinical index instead of the long-term clinical effect. Therefore, the study analyzes the long-term cost-effectiveness of Acarbose given in addition to existing treatments in patients of type 2 diabetes mellitus. Aim:The aim of this health economic study was to assess the cost-effectiveness of acarbose given in addition to existing treatments （either diet or sulphonylurea） in patients with type 2 diabetes in the Chinese setting, based on the findings of the MERIA study （a retrospective meta-analysis of clinical trials） so as to supply evidence and support for the policy decision for rational use of drugs and clinical guidelines.Content:Analyze the clinical effect of Acarbose in the treatment of type 2 diabetes mellitusMeasure the annual cost of type 2 diabetes and its complicationsPredict the cost-effectiveness of Acarbose given in addition to existing treatmentMethods:The CORE Diabetes Model, a peer-reviewed, published, validated computer simulation model, was used to simulate process of occurrence and development of diabetes and its complications, and project long-term clinical and cost outcomes in type 1 and type 2 diabetes patients receiving any treatment. The model is based on Markov model to calculate lifetime cost and clinical effect.Transition probabilities and the prevalence of complications were derived from published sources. Treatment effects and baseline cohort characteristics were based on the MERIA-meta analysis. Direct costs were retrieved from CODIC study, hospital records and expert opinion.Results:The results of the study indicated that acarbose treatment was associated with improvements in discounted life expectancy （0.27 years） and QALE （0.26 years） but was on average marginally more expensive than treatment in the placebo arm （RMB 17,081 per patient）. This led to incremental cost-effectiveness ratios of RMB 62,717 per life year gained and RMB 66,633 per quality-adjusted life year gained. An acceptability curve showed that with a willingness to pay of RMB 100,000, acarbose treatment was associated with a 76% probability of being cost-effective. Conclusion:This study demonstrated that addition of acarbose to existing treatment was associated with improvements in life expectancy and quality adjusted life expectancy. However, as long as the willingness to pay reaches 100,000 rmb, the therapy provides good value for money over patient lifetimes in the Chinese setting. |
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