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Table 3 Sensitivity analysis results: cost-effectiveness of 10 pharmacologic combination strategies and strategy ranking (per patient)

From: Choice across 10 pharmacologic combination strategies for type 2 diabetes: a cost-effectiveness analysis

Scenario

Item

Strategy 1

Strategy 2

Strategy 3

Strategy 4

Strategy 5

Strategy 6

Strategy 7

Strategy 8

Strategy 9

Strategy 10

Discount rate (costs and benefits) 3.5%

Cost, ¥ ($)a

49,164 (7117)

74,539 (10,790)

52,418 (7588)

77,860 (11,271)

56,539 (8185)

82,183 (11,897)

51,865 (7508)

77,920 (11,280)

64,782 (9378)

90,586 (13,113)

QALY

13.289

13.317

13.300

13.330

13.339

13.368

13.401

13.429

13.368

13.397

Rankb

5

9

6

10

2

7

1

4

3

8

Simulation time 30 years

Cost, ¥ ($)a

49,520 (7169)

73,411 (10,627)

52,981 (7669)

76,934 (11,137)

57,369 (8305)

81,512 (11,800)

52,475 (7596)

77,009 (11,148)

66,122 (9572)

90,417 (13,089)

QALY

13.615

13.639

13.627

13.652

13.666

13.692

13.730

13.755

13.696

13.721

Rankb

5

9

6

10

2

7

1

3

4

8

HbA1c thresholds of 7% and 8% for two therapy escalations

Cost, ¥ ($)a

65,349 (9460)

152,597 (22,090)

68,402 (9902)

155,817 (22,556)

72,036 (10,428)

160,022 (23,165)

66,064 (9563)

155,819 (22,556)

79,592 (11,522)

168,147 (24,341)

QALY

14.110

14.202

14.120

14.214

14.168

14.263

14.307

14.399

14.219

14.313

Rankb

4

9

5

10

3

8

1

6

2

7

Use UKPDS 82 risk equations to run model

Cost, ¥ ($)a

57,572 (8334)

91,305 (13,217)

61,250 (8867)

95,044 (13,759)

65,866 (9535)

99,854 (14,455)

58,536 (8474)

85,614 (12,393)

74,606 (10,800)

108,863 (15,759)

QALY

14.529

14.567

14.532

14.570

14.557

14.595

14.587

14.397

14.606

14.643

Rankb

2

6

5

9

4

8

1

10

3

7

Utility impact is + 0.017 and − 0.047 for per unit decrease and increase in BMI [365]

Cost, ¥ ($)a

52,923 (7661)

81,569 (11,808)

56,374 (8161)

85,095 (12,318)

60,741 (8793)

89,690 (12,984)

55,729 (8067)

85,142 (12,325)

69,467 (10,056)

98,597 (14,273)

QALY

14.446

14.510

14.476

14.541

14.566

14.632

14.830

14.894

14.651

14.717

Rankb

8

10

6

9

4

7

1

2

3

5

Probabilistic sensitivity analysis

Cost, ¥ ($)a

52,563 (7609)

82,077 (11,881)

56,194 (8135)

86,234 (12,483)

60,440 (8749)

90,647 (13,122)

55,150 (7983)

85,090 (12,318)

69,411 (10,048)

99,640 (14,424)

QALY

13.897

13.930

13.911

13.944

13.953

13.988

14.022

14.056

13.986

14.019

Rankb

5

9

6

10

2

7

1

4

3

8

Scenario analysisc

Δ Cost, ¥ ($)a

− 14,581 (− 2111)

6277 (909)

9495 (1375)

31,801 (4604)

6607 (956)

26,841 (3885)

− 14,805 (− 2143)

6542 (947)

25,963 (3758)

49,142 (7114)

Δ QALY

0.469

0.515

0.456

0.509

0.480

0.532

0.608

0.653

0.525

0.576

ICER, ¥ ($)/QALY

Dominantd

12,189 (1765)

20,836 (3016)

62,473 (9044)

13,754 (1991)

50,417 (7298)

Dominantd

10,018 (1450)

49,490 (7164)

85,380 (12,360)

  1. Strategy 1: metformin → metformin + sulfonylurea → metformin + insulin. Strategy 2: metformin → metformin + sulfonylurea → metformin + GLP-1 receptor agonist. Strategy 3: metformin → metformin + thiazolidinedione → metformin + insulin. Strategy 4: metformin → metformin + thiazolidinedione → metformin + GLP-1 receptor agonist. Strategy 5: metformin → metformin + α-glucosidase inhibitor → metformin + insulin. Strategy 6: metformin → metformin + α-glucosidase inhibitor → metformin + GLP-1 receptor agonist. Strategy 7: metformin → metformin + glinide → metformin + insulin. Strategy 8: metformin → metformin + glinide → metformin + GLP-1 receptor agonist. Strategy 9: metformin → metformin + DPP-4 inhibitor → metformin + insulin. Strategy 10: metformin → metformin + DPP-4 inhibitor → metformin + GLP-1 receptor agonist
  2. BMI body mass index, DPP-4 dipeptidyl peptidase 4, GLP-1 glucagon-like peptide 1, HbA1c glycosylated hemoglobin Alc, ICER incremental cost-effectiveness ratio, NMB net monetary benefit, QALY quality-adjusted life-year
  3. aFor the costs, data are 2019 Chinese yuan, ¥ (2019 US dollar, $). One US dollar was equal to ¥6.908 in 2019 [31]
  4. bThe strategies were ranked based on both the ICERs and the NMBs, as in the base-case analysis. The ICER is calculated as incremental costs divided by incremental QALYs of two strategies. The NMB is calculated as QALYs times willingness-to-pay/QALY, minus costs of each strategy. The larger the NMB value, the more cost-effective the strategy is. The ranking results based on the ICERs were equal to that based on the NMBs
  5. cIn the scenario analysis, the strategies were compared with nonpharmacologic treatment (only receiving lifestyle interventions and/or placebo, rather than glucose-lowering drugs)
  6. d“Dominant” indicates a strategy that is less costly and more effective than nonpharmacologic treatment; for example, strategy 7 is dominant over nonpharmacologic treatment