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Мрежов метаанализ разход/ефективност на неинсулиновите антидиабетни препарати

Д. Цанова, T. Веков


Introduction: Diabetes mellitus type 2 (DMT2) is a socially significant disease with enormous burden on society. The number of people with diabetes is progressively increasing - from 110 million in 1994, to 177 million in 2000, to 366 million in 2014 and according to WHO for 2030 the expectations are for 522 million. DMT2 is an expensive disease - about 10-15% of total expenditure of healthcare systems in developed countries is used for its treatment and more important for treatment of its complications.

The purpose of this study is to perform a systematic analysis of published data for health technology assessments (HTAs) for the treatment of DMT2, modeling expenses and health benefits based on indirect comparison. The aim is to validate results by comparing them with published relevant HTA.

Materials and Methods: A comprehensive literature search was performed from 2010 to 2016 for published data about health technology assessments for the treatment of DMT2. Modeling was done on expenditures and health benefits for noninsulin medicaments using network meta-analysis.

Results: The literature search in various databases found 30 relevant cost-effectiveness analyses for health technologies for treatment of DMT2 and 8 from multicenter randomized clinical trials. Indirect comparisons have been made with the current therapeutic alternatives for treatment of DMT2 thiazolidinediones (TZD), dipeptidyl peptidase 4 (DPP-4i) inhibitors, glucagon-like peptide 1 agonists (GLP-1ag), sodium glucose cotransporter inhibitors (SGLT2i).

Conclusion: Network meta-analysis shows that new therapeutic alternatives are cost-effective, administered as drugs at second or third line. The use of combination therapy achieves significantly better therapeutic outcomes compared to the corresponding monotherapy.


type 2 diabetes mellitus; treatment; noninsulin therapy; cost-effectiveness

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