{"title":"比较磺脲类药物和新型糖尿病药物作为 2 型糖尿病患者二线疗法的有效性和成本效益。","authors":"Matteo Franchi, Giacomo Pellegrini, Angelo Avogaro, Giuliano Buzzetti, Riccardo Candido, Arturo Cavaliere, Agostino Consoli, Irene Marzona, Francesco Saverio Mennini, Stefano Palcic, Giovanni Corrao","doi":"10.1136/bmjdrc-2023-003991","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to compare the effectiveness and cost-effectiveness profiles of glucagon-like peptide-1 receptor agonist (GLP-1-RA), sodium-glucose cotransporter 2 inhibitor (SGLT2i), and dipeptidyl peptidase-4 inhibitor (DPP-4i) compared with sulfonylureas and glinides (SU).</p><p><strong>Research design and methods: </strong>Population-based retrospective cohort study based on linked regional healthcare utilization databases. The cohort included all residents in Lombardy aged ≥40 years, treated with metformin in 2014, who started a second-line treatment between 2015 and 2018 with SU, GLP-1-RA, SGLT2i, or DPP-4i. For each cohort member who started SU, one patient who began other second-line treatments was randomly selected and matched for sex, age, Multisource Comorbidity Score, and previous duration of metformin treatment. Cohort members were followed up until December 31, 2022. The association between second-line treatment and clinical outcomes was assessed using Cox proportional hazards models. The incremental cost-effectiveness ratios (ICERs) were calculated and compared between newer diabetes drugs and SU.</p><p><strong>Results: </strong>Overall, 22 867 patients with diabetes were included in the cohort, among which 10 577, 8125, 2893 and 1272 started a second-line treatment with SU, DPP-4i, SGLT2i and GLP-1-RA, respectively. Among these, 1208 patients for each group were included in the matched cohort. As compared with SU, those treated with DPP-4i, SGLT2i and GLP-1-RA were associated to a risk reduction for hospitalization for major adverse cardiovascular events (MACE) of 22% (95% CI 3% to 37%), 29% (95% CI 12% to 44%) and 41% (95% CI 26% to 53%), respectively. The ICER values indicated an average gain of €96.2 and €75.7 each month free from MACE for patients on DPP-4i and SGLT2i, respectively.</p><p><strong>Conclusions: </strong>Newer diabetes drugs are more effective and cost-effective second-line options for the treatment of type 2 diabetes than SUs.</p>","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"12 3","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11131106/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparing the effectiveness and cost-effectiveness of sulfonylureas and newer diabetes drugs as second-line therapy for patients with type 2 diabetes.\",\"authors\":\"Matteo Franchi, Giacomo Pellegrini, Angelo Avogaro, Giuliano Buzzetti, Riccardo Candido, Arturo Cavaliere, Agostino Consoli, Irene Marzona, Francesco Saverio Mennini, Stefano Palcic, Giovanni Corrao\",\"doi\":\"10.1136/bmjdrc-2023-003991\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>We aimed to compare the effectiveness and cost-effectiveness profiles of glucagon-like peptide-1 receptor agonist (GLP-1-RA), sodium-glucose cotransporter 2 inhibitor (SGLT2i), and dipeptidyl peptidase-4 inhibitor (DPP-4i) compared with sulfonylureas and glinides (SU).</p><p><strong>Research design and methods: </strong>Population-based retrospective cohort study based on linked regional healthcare utilization databases. The cohort included all residents in Lombardy aged ≥40 years, treated with metformin in 2014, who started a second-line treatment between 2015 and 2018 with SU, GLP-1-RA, SGLT2i, or DPP-4i. For each cohort member who started SU, one patient who began other second-line treatments was randomly selected and matched for sex, age, Multisource Comorbidity Score, and previous duration of metformin treatment. Cohort members were followed up until December 31, 2022. The association between second-line treatment and clinical outcomes was assessed using Cox proportional hazards models. The incremental cost-effectiveness ratios (ICERs) were calculated and compared between newer diabetes drugs and SU.</p><p><strong>Results: </strong>Overall, 22 867 patients with diabetes were included in the cohort, among which 10 577, 8125, 2893 and 1272 started a second-line treatment with SU, DPP-4i, SGLT2i and GLP-1-RA, respectively. Among these, 1208 patients for each group were included in the matched cohort. As compared with SU, those treated with DPP-4i, SGLT2i and GLP-1-RA were associated to a risk reduction for hospitalization for major adverse cardiovascular events (MACE) of 22% (95% CI 3% to 37%), 29% (95% CI 12% to 44%) and 41% (95% CI 26% to 53%), respectively. 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引用次数: 0
摘要
简介我们旨在比较胰高血糖素样肽-1受体激动剂（GLP-1-RA）、钠-葡萄糖共转运体2抑制剂（SGLT2i）和二肽基肽酶-4抑制剂（DPP-4i）与磺脲类药物和格列奈类药物（SU）的有效性和成本效益：基于地区医疗保健使用数据库的人群回顾性队列研究。队列包括伦巴第大区所有年龄≥40 岁、2014 年接受二甲双胍治疗、2015 年至 2018 年期间开始接受 SU、GLP-1-RA、SGLT2i 或 DPP-4i 二线治疗的居民。对于每位开始接受 SU 治疗的队列成员，随机抽取一位开始接受其他二线治疗的患者，并对其性别、年龄、多源合并症评分和既往二甲双胍治疗时间进行匹配。对队列成员进行随访，直至 2022 年 12 月 31 日。二线治疗与临床结局之间的关系采用 Cox 比例危险模型进行评估。计算了增量成本效益比（ICER），并对新型糖尿病药物和 SU 进行了比较：共有 22 867 名糖尿病患者被纳入队列，其中分别有 10 577、8125、2893 和 1272 名患者开始接受 SU、DPP-4i、SGLT2i 和 GLP-1-RA 的二线治疗。其中，每组有 1208 名患者被纳入配对队列。与 SU 相比，接受 DPP-4i、SGLT2i 和 GLP-1-RA 治疗的患者因主要不良心血管事件（MACE）住院的风险分别降低了 22%（95% CI 3% 至 37%）、29%（95% CI 12% 至 44%）和 41%（95% CI 26% 至 53%）。ICER值显示，服用DPP-4i和SGLT2i的患者平均每月分别获得96.2欧元和75.7欧元的无MACE收益：结论：与 SUs 相比，新型糖尿病药物是治疗 2 型糖尿病更有效、更具成本效益的二线选择。
Comparing the effectiveness and cost-effectiveness of sulfonylureas and newer diabetes drugs as second-line therapy for patients with type 2 diabetes.
Introduction: We aimed to compare the effectiveness and cost-effectiveness profiles of glucagon-like peptide-1 receptor agonist (GLP-1-RA), sodium-glucose cotransporter 2 inhibitor (SGLT2i), and dipeptidyl peptidase-4 inhibitor (DPP-4i) compared with sulfonylureas and glinides (SU).
Research design and methods: Population-based retrospective cohort study based on linked regional healthcare utilization databases. The cohort included all residents in Lombardy aged ≥40 years, treated with metformin in 2014, who started a second-line treatment between 2015 and 2018 with SU, GLP-1-RA, SGLT2i, or DPP-4i. For each cohort member who started SU, one patient who began other second-line treatments was randomly selected and matched for sex, age, Multisource Comorbidity Score, and previous duration of metformin treatment. Cohort members were followed up until December 31, 2022. The association between second-line treatment and clinical outcomes was assessed using Cox proportional hazards models. The incremental cost-effectiveness ratios (ICERs) were calculated and compared between newer diabetes drugs and SU.
Results: Overall, 22 867 patients with diabetes were included in the cohort, among which 10 577, 8125, 2893 and 1272 started a second-line treatment with SU, DPP-4i, SGLT2i and GLP-1-RA, respectively. Among these, 1208 patients for each group were included in the matched cohort. As compared with SU, those treated with DPP-4i, SGLT2i and GLP-1-RA were associated to a risk reduction for hospitalization for major adverse cardiovascular events (MACE) of 22% (95% CI 3% to 37%), 29% (95% CI 12% to 44%) and 41% (95% CI 26% to 53%), respectively. The ICER values indicated an average gain of €96.2 and €75.7 each month free from MACE for patients on DPP-4i and SGLT2i, respectively.
Conclusions: Newer diabetes drugs are more effective and cost-effective second-line options for the treatment of type 2 diabetes than SUs.
期刊介绍：
BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of
high-quality — and evidence-based — original research articles.
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