OBJECTIVES: Frequent use of Type 2 Diabetes Mellitus (T2DM) drugs brings substantial economic burden to patients which could be eased by their successful listing into the National Reimbursement Drug List (NRDL) in China. Pharmacoeconomic evidence becomes increasingly important in reimbursement decision-making, with quality-adjusted life-year (QALY) being a critical indicator of health outcomes. This study aims to review published local economic evaluations (EEs) of negotiated T2DM drugs in 2020 NRDL and evaluate the range of QALY gains.

METHODS: Systematic literature review was conducted via CNKI, Wanfang Data, VIP, CBM, PubMed, Embase (OVID) and Web of Science to identify up-to-date EEs of negotiated T2DM drugs involved in 2020 NRDL negotiation by March 2021. Descriptive analyses were performed on extracted information including the study design (time horizon, model, comparator), QALY gains and other findings.

RESULTS: A total of 24 EEs were included, involving 6 negotiated T2DM drugs. The identified EEs comprised cost-utility analysis (83.3%), cost-effectiveness analysis (4.2%), cost-benefit analysis (4.2%) and cost-minimization analysis (8.3%). Among 20 model-based EEs, Cardiff diabetes model (40%), IQVIA CORE diabetes model (30%) and Markov model (15%) were primarily adopted. Median incremental QALY gain was 0.17 and average incremental QALY gain was 0.47 [standard deviation: 0.61]. The findings revealed that the economic assessments on the same drug varies in results depending on the choice of outcome indicator, comparator, model selection, time horizon and other factors.

CONCLUSIONS: The study design of identified EEs was generally aligned with China Pharmacoeconomics Guideline, and our analysis further shed some light on their convergence and divergence. The limitation of sample size and data quality may cause the variation in QALYs across studies. Economic evaluations evidence of higher quality are needed in the future to better support reimbursement decision-making on T2DM drugs in China.