目的 对达格列净+沙格列汀联合二甲双胍治疗2型糖尿病进行药物经济学评价。为单用二甲双胍控制不佳的糖尿病患者探寻较为合理的用药选择方案，同时为“糖尿病人头付费”提供有利依据，优化医保在糖尿病治疗方面的支出。方法 构建达格列净+沙格列汀联合二甲双胍和甘精胰岛素联合二甲双胍治疗2型糖尿病的Markov模型，展开队列模拟，对2种方案长期的成本和效用做出预测，以质量调整生命年（QALYs）为健康产出指标，以2024年人均国内生产总值（GDP）的3倍作为意愿支付值（WTP），分析增量成本-效用比（ICER）。对结果进行单因素敏感性分析和概率敏感性分析。结果 达格列净+沙格列汀联合二甲双胍治疗组改善0.19 QALYs，糖尿病并发症减少3.16%，死亡率降低1.54%,ICER是146 423.84元/QALYs，比WTP小，具备ICER优势，其增量成本可接受。单因素敏感性分析表示该研究稳定性较好，且概率性敏感性分析通过1 000次蒙特卡洛模拟结果表示达格列净+沙格列汀联合二甲双胍治疗组成本具有ICER优势概率为99.98%。结论 达格列净+沙格列汀联合二甲双胍为治疗2型糖尿病的优势方案。

Objective To conduct a pharmacoeconomic evaluation of the combination therapy of dapagliflozin + saxagliptin plus metformin for the treatment of type 2 diabetes. To explore more reasonable medication options for diabetic patients who are poorly controlled with metformin alone, and provide a favorable basis for the “diabetes capitation payment” to optimize the expenditure of medical insurance on diabetes treatment. Methods Markov model was constructed for the treatment of type 2 diabetes with the combination of dapagliflozin and saxagliptin with metformin, and the combination of insulin glargine and metformin. Using cohort simulation to predict the long-term costs and utilities of the two treatment regimens. Using three times the per capita gross domestic product（GDP） in 2024 as the willingness-to-pay threshold（WTP）, the incremental cost-effectiveness ratio（ICER） was analyzed. Conducting one-way sensitivity analysis and probabilistic sensitivity analysis on the results. Results The treatment group with dapagliflozin and saxagliptin with metformin improved by 0.17 QALYs, reduced diabetes complications by 3.16%, and decreased mortality by 1.54%. The ICER was 146 423.84 yuan/QALY, which is below WTP threshold, indicating a cost-effectiveness advantage, and the incremental cost is acceptable. The one-way sensitivity analysis showed that the study was relatively stable. The probabilistic sensitivity analysis, based on 1 000 Monte Carlo simulations, indicated that the probability of the treatment group with dapagliflozin and saxagliptin in combination with Metformin having a cost-effectiveness advantage was 99.98%. Conclusion For the treatment of type 2 diabetes with the combination of dapagliflozin and saxagliptin with metformin, and the combination of insulin glargine and metformin, the regimen of dapagliflozin and saxagliptin in combination with metformin is the dominant strategy.

R972

国家卫生健康委能力建设和继续教育中心资助项目(国家卫生健康委党校)(GWJJMB202510024013)