|
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)
|
- 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
- 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
- aFor the costs, data are 2019 Chinese yuan, ¥ (2019 US dollar, $). One US dollar was equal to ¥6.908 in 2019 [31]
- 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
- cIn the scenario analysis, the strategies were compared with nonpharmacologic treatment (only receiving lifestyle interventions and/or placebo, rather than glucose-lowering drugs)
- d“Dominant” indicates a strategy that is less costly and more effective than nonpharmacologic treatment; for example, strategy 7 is dominant over nonpharmacologic treatment
