Cost-effectiveness of insulin analogs from the perspective of the Brazilian public health system

被引:2
作者
Cazarim, Maurilio de Souza [1 ]
Vilela Rodrigues, Joao Paulo [1 ]
Coelho da Cruz-Cazarim, Estael Luzia [1 ]
Ayres, Lorena Rocha [2 ]
Leira Pereira, Leonardo Regis [1 ]
机构
[1] Univ Sao Paulo, Sch Pharmaceut Sci Ribeirao Preto, Pharmaceut Serv & Clin Pharm Res Ctr CPAFF, Dept Pharmaceut Sci, Ribeirao Preto, SP, Brazil
[2] Univ Fed Espirito Santo, Dept Pharmaceut Sci, Vitoria, ES, Brazil
基金
巴西圣保罗研究基金会;
关键词
Diabetes Mellitus/treatment/cost-effectiveness/evaluation; Prolonged Action Insulin; Short Action Insulin; Brazilian Public Health System; GLYCEMIC CONTROL; NPH INSULIN; TYPE-1; DETEMIR; ASPART; TRIAL; CARE;
D O I
10.1590/s2175-97902017000300178
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Human insulin is provided by the Brazilian Public Health System (BPHS) for the treatment of diabetes, however, legal proceedings to acquire insulin analogs have burdened the BPHS health system. The aim of this study was to perform a cost-effectiveness analysis to compare insulin analogs and human insulins. This is a pharmacoeconomic study of cost-effectiveness. The direct medical cost related to insulin extracted from the Ministry of Health drug price list was considered. The clinical results, i.e. reduction in glycated hemoglobin (HbA1c), were extracted by meta-analysis. Different scenarios were structured to measure the uncertainties regarding the costs and reduction in HbA1c. Decision tree was developed for sensitivity of Incremental Cost Effectiveness Ratio (ICER). A total of fifteen scenarios were structured. Given the best-case scenario for the insulin analogs, the insulins aspart, lispro, glargine and detemir showed an ICER of R$ 1,768.59; R$ 3,308.54; R$ 11,718.75 and R$ 2,685.22, respectively. In all scenarios in which the minimum effectiveness was proposed, lispro, glargine and detemir were dominant strategies. Sensitivity analysis showed that the aspart had R$ 3,066.98 [95 % CI: 2339.22; 4418.53] and detemir had R$ 6,163.97 [95% CI: 3919.29; 11401.57] for incremental costs. We concluded there was evidence that the insulin aspart is the most cost-effective.
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页数:8
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共 30 条
  • [1] Agencia Nacional de VigilAncia SanitAria. ANVISA, 2016, CAM REG MERC MED CME
  • [2] Reduction of postprandial hyperglycemia and frequency of hypoglycemia in IDDM patients on insulin-analog treatment
    Anderson, JH
    Brunelle, RL
    Koivisto, VA
    Pfutzner, A
    Trautmann, ME
    Vignati, L
    DiMarchi, R
    Bowen, KM
    Cameron, DP
    Nankervis, AJ
    Roberts, AP
    Zimmet, P
    Borkenstein, MH
    Schernthaner, G
    Waldhausl, WK
    DeLeeuw, IH
    Fery, F
    Scheen, A
    Somers, G
    Fettes, IM
    Tildesley, HD
    Toth, EL
    Viikari, J
    Altman, JJ
    Bougneres, PF
    Drouin, P
    Fossati, P
    Guillausseau, PJ
    Marechaud, E
    Riou, JP
    Selam, JL
    Vialettes, PB
    Beyer, J
    Federlin, K
    Fussganger, RD
    Gries, FA
    Jastram, HU
    Koop, I
    Landgraf, R
    Rosak, C
    Schatz, H
    SchulzeSchleppinghoff, B
    Seif, FJ
    Stoeckmann, F
    Karasik, A
    Weitzman, S
    Andreani, D
    Bompiani, G
    Crepaldi, G
    Giorgino, R
    [J]. DIABETES, 1997, 46 (02) : 265 - 270
  • [3] [Anonymous], 2019, DIABETES CARE, V42, pS1, DOI [10.2337/dc20-Sint, 10.2337/dc19-Sint01, 10.2337/dc19-SINT01, 10.2337/dc20-SINT, 10.2337/dc16-S001]
  • [4] Brasil. Instituto Brasileiro de Geografia e Estatistica. IBGE, ANTR EST NUTR CRIANC
  • [5] Comissao Nacional de Incorporacao de Tecnologias no SUS. CONITEC, 2013, INS AN DIAB MELL TIP
  • [6] Insulin analogues versus human insulin in type 1 diabetes: direct and indirect meta-analyses of efficacy and safety
    Conegero Sanches, Andreia Cristina
    Correr, Cassyano Januario
    Venson, Rafael
    Goncalves, Patricia Rodrigues
    Garcia, Mariana Martins
    Piantavini, Mario Sergio
    Pontarolo, Roberto
    [J]. BRAZILIAN JOURNAL OF PHARMACEUTICAL SCIENCES, 2013, 49 (03) : 501 - 509
  • [7] New insulins and new insulin regimens: a review of their role in improving glycaemic control in patients with diabetes
    Crasto, W.
    Jarvis, J.
    Khunti, K.
    Davies, M. J.
    [J]. POSTGRADUATE MEDICAL JOURNAL, 2009, 85 (1003) : 257 - 267
  • [8] Do Livramento FA, 2011, AMICUS CURIAE, V7, P1
  • [9] Drummond FM, 2005, METHODS EC EVALUATIO
  • [10] Evidence-based process for decision-making in the analysis of legal demands for medicines in Brazil
    Figueiredo, Tatiana Aragao
    Serpa Osorio-de-Castro, Claudia Garcia
    Edais Pepe, Vera Lucia
    [J]. CADERNOS DE SAUDE PUBLICA, 2013, 29 : S159 - S166