Abstract
This real-world, multicenter, prospective study aims to analyze the cost-effectiveness of prevalent oral antidiabetic drugs, including traditional Chinese medicine and its compounds, used in China. Type 2 diabetes patients initiated on one or several of the most prevalent antidiabetic drugs were recruited on the baseline and followed up over one year with no restriction on drug discontinuation, switching, and add-on. Different drugs were evaluated on their efficacy, adverse effect (AE), health-related quality of life (HRQoL), and cost. Treatments were defined as the intent-to-treat in the primary analysis and on-treatment in the sensitivity analyses. A rich set of patients' baseline characteristics was collected and controlled using the multivariate linear model in the primary analysis and inverse probability weighting and double selection—a machine learning algorithm—in the sensitivity analyses. Estimates of “raw” outcomes, which are not adjusted by covariates and calculated as subgroup means, show that the use of Xiaoke Pill alone and in combination is among the most effective therapies with 50% and 54% of patients reaching the control target of HbA1c < 6.5%. In terms of cost, Xiaoke Pill and gliclazide, which cost participants 4,350 and 5,150 RMB per year on average, are among the least costly therapies. After adjusting patient characteristics, monotherapy and combination therapy using the Xiaoke Pill again display the best control rates, of 45% and 43% against 33% of metformin. Regarding cost, the Xiaoke Pill costs a patient 5,340 RMB per year, in sharp contrast with 8,550 RMB for metformin and 10,330 RMB for acarbose. Our study suggests that the use of Xiaoke Pill—alone or in combination—is associated with better glycemic control and lower cost than some allopathic medications such as metformin or acarbose and shows a similar incidence of hypoglycemia.
Highlights
In 2019, 463 million adults aged between 20 and 79 years had diabetes mellitus worldwide, and the number is projected to reach 578 million by 2030 and 700 million by 2045 [1]. e high prevalence of diabetes represents huge health and economic burdens
In China, diabetes is treated with both allopathic medicines and traditional Chinese medicine (TCM). e history of using TCMs as a treatment for diabetes is over 2000 years [4]
A survey conducted at 75 hospitals in nine cities found that the proportions of patients treated with biguanides, sulfonylurea, meglitinides, glitazones, α-glucosidase inhibitors, and others were 78.4%, 65.1%, 14.0%, 12.6%, 31.1%, and 18.1%, Evidence-Based Complementary and Alternative Medicine respectively
Summary
In 2019, 463 million adults (one in 11 adults) aged between 20 and 79 years had diabetes mellitus worldwide, and the number is projected to reach 578 million by 2030 and 700 million by 2045 [1]. e high prevalence of diabetes represents huge health and economic burdens. In 2019, an estimated $ 760 billion was spent on diabetes treatment, making up 10% of the global health expenditure spent on adults [1]. In China, an estimated 129.8 million adults have diabetes, which accounts for 11.2% of its adult population [3], and the health expenditure attributed to diabetes was estimated to be $ 63 billion [1]. In China, diabetes is treated with both allopathic medicines and traditional Chinese medicine (TCM). Oral antidiabetic drugs on 2018 China’s National Essential Medicines, which is the most recently issued guidance for purchase and reimbursement of essential drugs by healthcare providers in China, include both allopathic drugs, such as metformin, glibenclamide, glipizide, glimepiride, gliquidone, gliclazide, acarbose, dapagliflozin, liraglutide, repaglinide, pioglitazone, sitagliptin, and linagliptin, and TCMs, such as the Xiaoke Pill (Xiao Ke Wan in Chinese)
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