胰岛素强化治疗新诊断2型糖尿病患者成本-效果分析

目的 分析3种胰岛素强化治疗方案的成本-效果，为选择临床治疗方案提供参考。方法 对新诊断2型糖尿病患者随机分为3组。A组仅给予持续皮下注射胰岛素（CSII）,B组给予CSII联合二甲双胍和吡格列酮，C组给予CSII联合西格列汀。收集治疗前后的空腹血糖（FPG）、餐后2 h血糖（2hPG）、血糖达标时间、住院天数、低血糖发生次数及成本，比较3种方案的成本-效果。结果 各组患者经治疗后FPG、2hPG均下降（均P<0.01）,3组的血糖达标时间、住院天数及低血糖发生次数差异均有统计学意义（均P<0.01）。A、B、C组有效率的成本-效果比分别为139.37、134.29、135.66。以A组为对照，B组和C组的增量成本-效果比分别为25.52、53.85。敏感性分析支持基础分析结果。结论 CSII联合二甲双胍和吡格列酮治疗新诊断2型糖尿病患者是最经济、有效的方案；对于低血糖发生危险性高的患者，可选CSII联合西格列汀。

Cost-effectiveness analysis of insulin intensive therapy for newly diagnosed type 2 diabetes mellitus patients

Objective To analyze the cost-effectiveness of three kinds of different insulin intensive treatment regimes, and to provide a reference for the selection of clinical treatment regimens. Methods Patients with newly diagnosed type 2 diabetes mellitus （T2DM） were randomly divided into three groups. Group A, continuous subcutaneous insulin infusion （CSII） alone; group B, CSII combined with metformin and pioglitazone; group C, CSII combined with sitagliptin. Fasting blood glucose （FPG） and 2-hour postprandial blood glucose （2hPG） before and after treatment, the days of reaching the target of blood glucose, the hospitalization days, the frequency of hypoglycemia, and the costs of the different regimes were recorded, and the cost-effectiveness of the three regimes was compared. Results All groups showed significantly decreased FPG and 2hPG post-treatment （all P<0.01）, and the days of reaching the target of blood glucose, the hospitalization days, and the frequency of hypoglycemia among the three groups were statistically significant （all P<0.01）. The cost-effectiveness ratio of the effective rate was 139.37, 134.29, and 135.66, respectively. Compared with group A, the incremental cost-effectiveness ratios for group B and group C were 25.52 and 53.85, respectively. The results of sensitivity analysis supported the results of basic analysis. Conclusion CSII combined with metformin and pioglitazone therapy is the most cost-effective treatment for newly diagnosed T2DM. For patients with a high risk of hypoglycemia, CSII combined with sitagliptin is available.