2型糖尿病患者强化管理的长期成本效果评价：长期花费与预后的模型研究

目的评估糖尿病患者强化降糖管理与标准治疗的长期成本效用。方法应用糖尿病计算机模拟模型（CORE糖尿病模型）来预测长期（30年）的健康及卫生经济学情况。模拟的数据来自社区-医院一体化管理的300例2型糖尿病患者，随机分为强化治疗组（n=145）和标准治疗组（n=155），为期54个月。结果较标准治疗组，强化治疗组的视网膜病变、肾脏病变和心血管病变的累积发生率明显减少；背景期视网膜病变、终末期肾病、足溃疡、充血性心力衰竭和心肌梗死事件的发生分别降低4．299％、0．814％、2．357％、2．594％和4．003％。强化治疗组的期望寿命显著增加了（0．476±0．251）年，而与此相关的质量调整生命年（QALYs）增加了0．418±0．173，直接医疗成本增加5940元。而增量成本效果比增加14217元。结论2型糖尿病患者强化管理治疗能显著降低糖尿病并发症的发生率，改善长期预后；强化管理治疗与期望寿命和质量调整生命年的改善有关。

Evaluating the long-term cost-effectiveness ratio of intensive glycaemic control versus conventional glucaemic control in patients with type 2 diabetes mellitus:A modeling study of long-term costs and health outcomes

Objective To evaluate the long-term cost-effectiveness ratio of intensive glycaemic control versus conventional glycaemic control in patients with type 2 diabetes mellitus （T2DM） in China. Methods A published and validated computer simulation model of diabetes （CORE Diabetes Model） was used to predict long-term （30 years） of health and economic outcomes. Simulated cohorts and treatment effects were derived from 300 diabetic patients in community medical center who were divided randomly into intensive glycaemic control group （n=145） and conventional glycaemic control group （n=155） for 54 months. Results Compared with conventional glycaemic control, intensive glycaemic control showed the reduced cumulative incidences of eye disease, renal disease, foot ulcer and cardiovascular disease （all P 〈0.05）. Background retinopathy, end-stage renal disease, foot ulcer, congestive heart failure , myocardial infarction events were reduced by 4.299%, 0.814%, 2.357%, 2.594% and 4.003%, respectively. Therapy of intensive glycaemic control improved life expectancy significantly （0. 476±0. 251 years） and associated with improvements by 0. 418 ± 0. 173 quality-adjusted life years （QALYs）, but increased direct medical costs by Chinese Yuan （CNY） 5, 940 per patient as compared to coventional glycaemic control. However, the incremental cost-effectiveness ratio was calculated as CNY 14, 217 per QALY gained. Conclusion The intensive glycaemic control reduces the cumulative incidences ofdiabetes complications and improves long term health outcomes for patients with T2DM. Intensive glycaemic control in T2DM patients in China is associated with improvements in life expectancy and QALYs.