目的 对二甲双胍控制不佳的2型糖尿病（T2DM）患者使用二甲双胍分别联合度拉糖肽或者西格列汀治疗的长期经济性进行评价。方法 从我国的卫生经济角度出发，构建度拉糖肽（试验组）以及西格列汀（对照组）分别联用二甲双胍治疗T2DM的Markov模型。展开队列模拟，预测2种治疗方案的长期成本及效用，以质量调整生命年（QALYs）为健康产出指标，以2024年我国人均国内生产总值（GDP）的3倍作为意愿支付（WTP）阈值，分析增量成本-效果比（ICER），并对结果进行敏感性分析及情境分析。结果 模型运行30个周期后，试验组使有并发症患者的概率降低41.5%，死亡率降低15.84%，累计效用改善0.51 QALYs，ICER为97 316.35元·QALY^-1，小于本研究设定的WTP阈值（287 427元·QALY^-1），具有成本-效用优势，增加的成本可接受。单因素敏感性分析显示该研究的稳定性较好。概率敏感性分析结果示： WTP为114 898.8元·QALY^-1时，试验组具有68.2%的成本-效用优势，随着WTP的提高，度拉糖肽组治疗方案的经济性越来越大。情境分析结果：度拉糖肽价格下降20%以后，试验组成本-效用优势更加明显。结论 与西格列汀联合二甲双胍相比，度拉糖肽联合二甲双胍在T2DM治疗中的长期经济性更具优势。

Objective To evaluate the long-term pharmacoeconomic profile of dulaglutide vs sitagliptin in patients with type 2 diabetes mellitus (T2DM) inadequately controlled by metformin monotherapy. Methods From the perspective of Chinese health economics, Markov model for dulaglutide combined with metformin and sitagliptin combined with metformin was constructed to compare the therapeutic regimens of in the treatment of T2DM, respectively. A cohort simulation was conducted to predict the long-term costs and utilities of the two treatment regimens. Quality-adjusted life years (QALYs) were used as the health outcome indicator, and three times the per capita gross domestic product (GDP) of China in 2024 was set as the willingness-to-pay (WTP) threshold, based on which the incremental cost-effectiveness ratio (ICER) was analyzed, along with sensitivity analysis and scenario analysis of the results. Results After 30 cycles of model operation, intervention group regimen reduced the probability of patients developing complications by 41.5% and the mortality rate was decreased by 15.84%, with a cumulative utility improvement of 0.51 QALYs. The ICER was 97 316.35 yuan per QALY, which was less than the WTP threshold set in this study (287 427 yuan per QALY). This indicated that the intervention group regimen had cost-utility advantages, and the additional costs incurred were acceptable. Univariate sensitivity analysis indicated that the study was relatively stable. Findings of the probabilistic sensitivity analysis demonstrated that when the WTP threshold was 114 898.8 yuan per QALY, the dulaglutide group had a 68.2% probability of cost-utility superiority. Moreover, the economic efficiency of the experimental group regimen increased with the elevation of the WTP threshold. Scenario analysis results revealed that after a 20% price reduction of dulaglutide, the ICER value of this regimen decreased significantly, and its cost-utility advantages become more prominent. Conclusion Compared with sitagliptin combined with metformin, dulaglutide in combination with metformin demonstrates superior long-term economic benefits in the treatment of T2DM.

R956

DRG/DIP实施背景下GLP-1RA类降糖药的综合评价及其对医疗服务管理影响（YDGWYFK）；北京慢性病防治与健康教育研究会（MBZX0092024005，MBZX0112024001）