Economic Evaluation of Thiazolidinediones as Add-on Therapy for Treatment of Type 2 Diabetic Patients in the Taiwanese National Health Insurance System

全民健康保險制度下糖尿病病患合併使用Thiazolidinediones 之經濟評估

蕭斐元(Fei-Yuan Hsiao) ； C. Daniel Mullins ； 黃文鴻(Weng-Foung Huang)

《藥物食品分析》 20卷2期 (2012/06) Pp. 431-437

https://doi.org/10.6227/jfda.2012200201

並列摘要

The cost-effectiveness of adding the two health insurance covered thiazolidinediones (TZDs)-rosiglitazone or pioglitazone, to metformin in treating type 2 diabetes mellitus was assessed from a Taiwanese National Health Insurance (NHI) perspective.This analysis was based on patient-level data extracted from Taiwan's NHI databases. Type 2 diabetic patients who received consecutive metformin treatments between 2001 and 2005 were identified. Clinical effectiveness, a proxy of glycemic control (time to insulin dependence), and direct medical cost were also estimated. Incremental cost-effectiveness ratio (ICER) was calculated and expressed as cost per delayed year to insulin dependence.Compared to add-on non-TZDs, add-on rosiglitazone and pioglitazone were associated with delays of additional 151 days (0.41 years) and 101 days (0.28 years) in insulin dependence, respectively. Total mean medical costs were higher in add-on TZDs users compared to add-on non-TZDs users. The additional total medical costs of add-on rosiglitazone or pioglitazone were comparable, with ICERs of 95,874 and 95,485 New Taiwan (NT) dollars per year delay in insulin dependence, respectively.Add-on TZDs improves glycemic control but also increases direct medical cost. In terms of the incremental medical costs associated with these clinical benefits, add-on rosiglitazone or pioglitazone are similar in Taiwan.

並列關鍵字

thiazolidincdiones (TZDs) ； cost-effectiveness ； incremental cost-effectiveness ratio (lCER) ； diabetes mellitus ； national health insurance

參考文獻

Wild, S., Roglic, G., Green, A., Sicree, R. and King, H. 2004. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 27: 1047-1053.

Diamant, M. and Heine, R. J. 2003. Thiazolidinediones in type 2 diabetes mellitus: current clinical evidence. Drugs. 63: 1373-1405.

UK Prospective Diabetes Study Group. 1998. Effect of intensive blood glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 352: 854-865.

Gaede, P., Vedel, P., Larsen, N., Jensen, G. V., Parving, H. H., and Pedersen, O. 2003. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N. Engl. J. Med. 348: 383-393.

White, J. R. 2002. Economic considerations in treating patients with type 2 diabetes mellitus. Am. J. Health. Syst. Pharm. 59 Suppl 9: S14-S17.