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Diabetologie und Stoffwechsel 2010; 5(1): 32-39
DOI: 10.1055/s-0029-1224723
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© Georg Thieme Verlag Stuttgart ˙ New York

Kosteneffektivität von Pioglitazon bei Patienten mit Typ-2-Diabetes und makrovaskulären Vorerkrankungen in Deutschland

Cost-Effectiveness of Pioglitazone in Patients with Type 2 Diabetes and a History of Macrovascular Disease in GermanyR. Bierwirth1 , A. Liebl2 , M. H. Gschwend3
  • 1Diabetes-Praxis, Essen
  • 2Diabetes- und Stoffwechselzentrum, m & i-Fachklinik Bad Heilbrunn
  • 3IMS Health, Allschwil, Schweiz
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Publication History

Publication Date:
24 February 2010 (online)

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Zusammenfassung

Die mit der Behandlung des Typ-2-Diabetes verbundenen direkten Kosten machen einen erheblichen Anteil der Gesundheitskosten in Deutschland aus, wobei der größte Kostenfaktor die mit dem Diabetes auftretenden Komplikationen sind. Solche Komplikationen durch geeignete Interventionen zu vermeiden ist daher nicht nur unter klinischen, sondern auch unter ökonomischen Gesichtspunkten sinnvoll. In der PROactive-Studie wurde gezeigt, dass Pioglitazon bei Typ-2-Diabetikern mit makrovaskulären Vorerkrankungen das Risiko für weitere kardiovaskuläre Komplikationen reduziert. Auf Basis der Wirksamkeitsdaten der PROactive-Studie wurde inzwischen die Kosteneffektivität von Pioglitazon über 35 Jahre modelliert. Die Ergebnisse dieser gesundheitsökonomischen Analyse wurden kürzlich in der Zeitschrift „Cost Effectiveness and Resource Allocation“ publiziert. Pioglitazon führt über einen Zeitraum von 35 Jahren zu einem Zugewinn von 0,120 qualitätsadjustierten Lebensjahren (QALYs) bei einem zusätzlichen Kostenaufwand von 9281 € pro gewonnenem Lebensjahr und 13 294 € pro gewonnenem QALY. Setzt man die allgemein akzeptierte Bereitschaft voraus, 50 000 € pro gewonnenem QALY zu zahlen, kann Pioglitazon mit einer Wahrscheinlichkeit von 78,2 % als kosteneffektiv angesehen werden. Auf Basis einer Datenbankrecherche wurden Kosteneffektivitätsdaten zu Therapien chronischer Erkrankungen anderer gesundheitsökonomisch relevanter Indikationen ermittelt und diese mit den Ergebnissen zu Pioglitazon in der Therapie des Typ-2-Diabetes verglichen. Es konnte gezeigt werden, dass der Zugewinn an Lebensjahren und QALYs sowie der damit verbundene zusätzliche Kostenaufwand für den Einsatz von Pioglitazon vergleichbar mit den Ergebnissen entsprechender Analysen zum Einsatz von Statinen in der Sekundärprävention und zur antihypertensiven Therapie ist. Gegenüber TNF-alpha-Inhibitoren zur Therapie der rheumatioiden Arthritis ist Pioglitazon kosteneffektiver. 

Abstract

The direct costs associated with the treatment of type 2 diabetes account for a considerable proportion of healthcare costs in Germany, with diabetes-related complications being the biggest cost factor. Therefore avoiding such complications by suitable interventions is a reasonable approach, not only from clinical but also from economic aspects. It was shown in the PROactive study that pioglitazone reduces the risk for further cardiovascular complications in type 2 diabetes patients with a history of macrovascular disease. On the basis of the efficacy data of the PROactive trial, the cost-effectiveness of pioglitazone has meanwhile been modelled over a 35-year period. The results of this health economic analysis were published recently in the journal “Cost Effectiveness and Resource Allocation”. Over a 35-year period treatment with pioglitazone was associated with a gain of 0.120 quality-adjusted life years (QALYs) at an additional cost of € 9281 per life year gained and € 13 294 per QALY gained. Assuming a willingness-to-pay threshold of € 50 000 per QALY gained, there is a 78.2 % likelihood that pioglitazone would be considered cost-effective. On the basis of a database search, cost-effectiveness data on the treatments of chronic diseases from other indications of relevance to healthcare economics were identified and compared with the results for pioglitazone in the treatment of type 2 diabetes. It was shown that the gain in life years and QALYs along with the associated additional cost for the use of pioglitazone is comparable with the results of corresponding analyses on the use of statins in secondary prevention and on anti -hypertensive therapy. Compared with TNF-alpha inhibitors for the treatment of rheumatoid arthritis, pioglitazone is more cost effective. 

Schlüsselwörter

Typ-2-Diabetes - Pioglitazon - PROactive - Kosteneffektivität - Gesundheitsökonomie

Key words

type 2 diabetes - pioglitazone - PROactive - cost-effectivenes - health economy

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Dr. Ralph-Achim Bierwirth

Diabetes-Praxis

Herwarthstraße 102

45138 Essen

Phone: 02 01 / 43 64 57 0

Fax: 02 01 / 43 64 57 1

Email: bierwirth.diab@web.de

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