The cost-effectiveness of metformin in pre-diabetics: a systematic literature review of health economic evaluations

Objectives: Our aim was to systematically identify and appraise cost-effectiveness studies of metformin in prediabetic subjects. Methods: A systematic literature review was conducted and reported according to standard guidlines. The search was conducted in PubMed, Embase, International Society for Pharmacoeconomics and Outcomes Research (ISPOR) presentation database and the Cost-Effectiveness Analysis (CEA) and Center for Reviews and Dissemination (CRD) registries. All cost-effectiveness studies assessing metformin in prediabetic patients were included. Results: Twenty-three reports were included. Metformin and intensive lifestyle changes (ILC) interventions were always cost-effective compared to placebo. ILC was cost-effective and sometimes dominant compared to metformin. Metformin was cost-saving compared to ILC in the short and medium-term. Although, in the long term, metformin was more expensive than ILC in terms of direct medical costs, when indirect non-medical costs are included, metformin less expensive than ILC. One study reported that for patients with Body Mass Index (BMI) higher than 30 kg/m2, metformin is a cost-effective strategy compared to placebo and ILC. However, this finding was not confirmed by other retrieved studies. Conclusion: ILC is cost-effective compared to metformin and, both of them are cost-effective compared to placebo. Metformin may be cost-saving in the short- to medium-term and possibly in the long-term.

研究目的：本研究旨在系统识别并评价二甲双胍用于前驱糖尿病受试者的成本效益相关研究。方法：本研究遵循标准指南开展系统文献综述并报告研究结果。检索范围涵盖PubMed、Embase、国际药物经济学与结果研究学会（International Society for Pharmacoeconomics and Outcomes Research, ISPOR）会议论文数据库，以及成本效益分析（Cost-Effectiveness Analysis, CEA）注册库与循证评价与传播中心（Center for Reviews and Dissemination, CRD）注册库。最终纳入所有评估二甲双胍用于前驱糖尿病患者的成本效益研究。结果：共纳入23篇研究报告。与安慰剂相比，二甲双胍与强化生活方式干预（Intensive Lifestyle Changes, ILC）均始终具备成本效益。相较于二甲双胍，强化生活方式干预具备成本效益，且有时可占据优势（即成本更低且临床获益更优）。短期与中期内，二甲双胍相较于强化生活方式干预可实现成本节约。尽管长期来看，二甲双胍的直接医疗成本高于强化生活方式干预，但纳入间接非医疗成本后，二甲双胍的总成本反而低于强化生活方式干预。另有一项研究显示，对于体质指数（Body Mass Index, BMI）≥30 kg/m²的患者，相较于安慰剂与强化生活方式干预，二甲双胍是具备成本效益的干预策略，但该结论未被其余纳入研究证实。结论：相较于二甲双胍，强化生活方式干预具备成本效益；二者与安慰剂相比均具备成本效益。二甲双胍在短期至中期内可实现成本节约，长期场景下亦可能具备成本节约效应。