Page 71 - 《中国药房》2020年23期

·药物经济学·

基于净效益回归框架的胰岛素类似物与人胰岛素治疗 2 型糖尿

病的成本-效果分析 Δ

邓 丹 ，明 鑫 ，尹 锦 ，王 怡 ，钱 妍（1.重庆医科大学公共卫生与管理学院，重庆 400016；2.重庆市
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妇幼保健院质量管理科，重庆 401147；3.成都天府新区疾病预防控制中心，成都 610213；4.重庆医科大学附
属第二医院药学部，重庆 400010）
中图分类号 R587.1；R956 文献标志码 A 文章编号 1001-0408（2020）23-2877-05
DOI 10.6039/j.issn.1001-0408.2020.23.11
摘 要 目的：比较胰岛素类似物与人胰岛素治疗2型糖尿病的成本-效果，减轻患者疾病经济负担，同时为非随机化的药物经济
学研究提供新思路。方法：采用重庆市某三级甲等医院的回顾性数据，共纳入533例2型糖尿病患者为研究对象，通过倾向性评分
匹配平衡组间差异，构建净效益回归框架来分析胰岛素类似物与人胰岛素治疗2型糖尿病的成本-效果。结果：两种治疗方案的疗
效与成本存在正向关系——胰岛素类似物的疗效优于人胰岛素，两者总有效率相差14.5％；相应的治疗成本也是胰岛素类似物高
于人胰岛素，平均总成本相差960.3元。每增加1个单位临床效果（即总有效率），胰岛素类似物组患者需要比人胰岛素组多花费
66.23 元。净效益回归分析结果显示，患者选择治疗方案的支付意愿临界值为 16 947.5 元。结论：当患者的最大支付意愿大于
16 947.5元时，适宜选择胰岛素类似物治疗方案；反之，则适宜选择人胰岛素治疗方案。倾向性评分技术应用于净效益回归分析
可以为非随机化药物经济学拓宽可用数据的来源。
关键词 2型糖尿病；人胰岛素类似物；人胰岛素；倾向性评分匹配；净效益回归框架；成本-效果分析

Cost-effectiveness Analysis of Insulin Analogues and Human Insulin in the Treatment of Type 2 Diabetes
Mellitus Based on Net-benefit Regression Framework
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DENG Dan ，MING Xin ，YIN Jin ，WANG Yi ，QIAN Yan（1. School of Public Health and Management，
Chongqing Medical University，Chongqing 400016，China；2. Dept. of Quality Management，Chongqing Health
Center for Women and Children，Chongqing 401147，China；3. Chengdu Tianfu New Area Center for Disease
Control and Prevention，Chengdu 610213，China；4. Dept. of Pharmacy，the Second Affiliated Hospital of
Chongqing Medical University，Chongqing 400010，China）
ABSTRACT OBJECTIVE：To compare the cost-effectiveness of insulin analogues and human insulin in the treatment of type 2
diabetes mellitus，to reduce economic burden of patients，and to provide new ideas for non-randomized pharmacoeconomic
research. METHODS：Retrospective data of a Third-grade Class-A hospital were adopted and 533 patients with type 2 diabetes
were taken as object to balance the difference between groups through propensity score matching，and construct net-benefit
regression framework so as to analyze the cost-effectiveness of insulin analogues and human insulin in the treatment of type 2
diabetes mellitus. RESULTS：There was a positive relationship between the efficacy and cost of the two therapeutic schemes，i.e.
insulin analogues were more effective than human insulin，and the difference of total effective rate between the two schemes was
14.5％. The corresponding treatment cost of insulin analogues was higher than that of human insulin，and the average total cost
difference was 960.3 yuan. The cost of insulin analogues was 66.23 yuan more than that of human insulin for each additional unit of
clinical effect（total effective rate）. Results of net-benefit regression analysis showed that critical value of willingness to pay of
therapy plan was 16 947.5 yuan. CONCLUSIONS：When the willingness to pay is more than 16 947.5 yuan，the insulin analogue
scheme is suitable；on the contrary，the human insulin analogue scheme is suitable. The propensity scoring technology used for the
net-benefit regression analysis can broaden the source of avaliable data for non-randomized pharmacoeconomic evaluation.
KEYWORDS Type 2 diabetes mellitus；Insulin analogues；Human insulin；Propensity scoring matching；Net-benefit regression
framework；Cost-effectiveness analysis

[1]
糖尿病是一种以高血糖为特征的临床常见疾病 。
Δ 基金项目：重庆市自然科学基金资助项目（No.cstc2018jcy-
据国际糖尿病联盟统计，2019年全球成年糖尿病患者约
jAX0184）；重庆市高校人文社会科学类研究项目（No.17SKG025）
[2]
＊教授，博士。研究方向：人群健康与统计决策。电话：023- 有 4.63 亿，该数字于 2045 年将可能达到 7 亿 。而中国
[3]
68485008。E-mail：100079@cqmu.edu.cn 作为全球人口大国，糖尿病患者人数高达 1.164 亿 ，是
中国药房 2020年第31卷第23期 China Pharmacy 2020 Vol. 31 No. 23 ·2877 ·