在慢性病中使用达帕格利弗洛辛:超出DAPA-CKD试验的成本效益
Phil McEwan1, Jason A Davis1, Peter D Gabb1
1Health Economics and Outcomes Research Ltd, Cardiff, UK.
Clinical kidney journal
|February 23, 2024
概括
达帕格利弗洛辛是一种具有成本效益的治疗慢性病 (CKD) 在广泛的患者群体,包括那些有和没有2型糖尿病. 这项基于DAPA-CKD和DECLARE-TIMI 58试验的分析支持其在各种医疗保健系统中的应用.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 药物经济学 药物经济学
- 临床试验 临床试验
背景情况:
- 达帕格利弗洛辛和预防慢性病中不良结果 (DAPA-CKD) 试验包括中度至晚期慢性病 (eGFR 25-75 mL/min/1.73 m2和UACR >200 mg/g) 的患者.
- 达帕格利弗洛辛对心血管LAR事件-心肌梗塞中血栓溶解的影响58 (DECLARE-TIMI 58) 试验招募了患有2型糖尿病和更广泛的功能标准的患者,没有白蛋白尿值.
- 这些试验为评估在更广泛的CKD患者中达帕格利弗洛辛的成本效益提供了基础.
研究的目的:
- 在广泛的慢性病 (CKD) 患者群体中估计达帕格利弗洛辛的成本效益.
- 利用DAPA-CKD和DECLARE-TIMI 58试验的患者级数据进行全面的经济评估.
- 评估达帕格利弗洛辛在不同的医疗保健系统中的价值,包括英国,西班牙,意大利和日本.
主要方法:
- 适应已发表的马尔科夫模型,最初基于DAPA-CKD试验,以纳入更广泛的患者群体.
- 包括来自DAPA-CKD和DECLARE-TIMI 58试验的患者级数据,而不考虑基线albuminuria.
- 从现有文献和DAPA-CKD试验中获取成本和效用数据,以终身视野和医疗保健系统视角.
主要成果:
- 据预测,达帕格利弗洛辛治疗将使预期寿命延长约0.64年,并在研究国家增加0.45-0.68年的质量调整寿命年 (QALYs).
- 发现增量成本效益比率 (ICER) 低于国家特定的支付意愿门,从意大利的7771美元/QALY到西班牙的14479美元/QALY.
- 亚组分析表明,无论尿中的白蛋白与肌素的比率或2型糖尿病状态如何,达帕格利弗洛辛的成本效益都保持不变.
结论:
- 达帕格利弗洛辛在更广泛的慢性病 (CKD) 患者中表现出比以前确定的更大的成本效益.
- 经济效益延伸到估计各异的淋巴膜过率和白色素尿水平的患者.
- 研究结果支持在英国,西班牙,意大利和日本等多种医疗保健系统中使用达帕格利弗洛辛,用于患有或没有2型糖尿病的患者.
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