OBJECTIVE To assess the long-term cost-effectiveness of five glucagon-like peptide-1 receptor agonists(GLP-1RAs)in the treatment of poorly controlled type 2 diabetes mellitus(T2DM)treated with metformin.METHODS Baseline data from patients in previously published meta-analysis and included randomized controlled trials(RCTs)were extracted to predict survival,long-term efficacy,and costs for each group using the United Kingdom prospective diabetes study outcome model 2.1.The cost-effectiveness of 5 GLP-1RAs(liraglutide,lixisenatide,exenatide,dulaglutide,and semaglutide)was analyzed by cost-utility analysis.Sensitivity analysis and scenario analysis were also performed to verify the uncertainty of basic analysis results.RESULTS A total of 21 RCTs with 6 796 patients were included.Survival analysis curves showed the superiority of semaglutide in reducing the risk of death from cardiovascular disease and dulaglutide in reducing the risk of all-cause mortality over other GLP-1RAs.The cost-utility analysis showed that the five drugs were economically superior to inferior in the order of lixisenatide,semaglutide,exenatide,dulaglutide,and liraglutide;one-way and probabilistic sensitivity analyses indicated that the results were robust.The scenario analysis results indicated that the price of semaglutide should decrease by at least 54.64%to 369.21 yuan,which is cost-effectiveness compared to lixisenatide.CONCLUSIONS For T2DM patients in China with poor glycemic control after treatment with metformin,lixisenatide and semaglutide may be considered as the preferred regimen.
维普
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