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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