ObjectiveTo systematically review the efficacy and safety of premixed insulin lispro versus insulin glargine for type 2 diabetes mellitus (T2DM). MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 3, 2013), PubMed, EMbase, ClinicalTrials.gov, CBM, CNKI and WanFang Data were searched up to October 2013 for randomized controlled trials (RCTs) about the clinical efficacy and safety of premixed insulin lispro versus insulin glargine for T2DM. Two reviewers independently screened literature according to the exclusion and inclusion criteria, extracted data, and assessed methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 13 RCTs involving 4 557 patients were included. The results of meta-analysis showed that:compared to insulin glargine, premixed insulin lispro was more effective in reducing levels of HbA1c (parallel trials:WMD=-0.18, 95%CI-0.33 to-0.02, P=0.03; cross-over trials:WMD=-0.38, 95%CI-0.52 to-0.24, P < 0.000 01). However, insulin glargine was more effective in reducing levels of FPG (parallel trials:WMD=0.82, 95%CI 0.65 to 0.99, P < 0.000 01; cross-over trials:WMD=0.64, 95%CI 0.26 to 1.02, P=0.000 9), weight gain (parallel trials:WMD=0.93, 95%CI 0.31 to 1.56, P=0.003; cross-over trials:WMD=0.74, 95%CI 0.19 to 1.29, P=0.009), and decreased the incidence of hypoglycemia (parallel trials:OR=1.26, 95%CI 1.10 to 1.45, P=0.000 6; cross-over trials:OR=2.24, 95%CI 1.45 to 3.46, P=0.000 3). ConclusionFor T2DM patients, premixed insulin lispro and insulin glargine have different advantages in clinical efficacy and safety. Doctors should select appropriate insulin treatment according to patients' health conditions.
ObjectiveTo systematically review the health-related quality of life (QOL) based on EQ-5D instrument for disease population in China. MethodsWe searched databases including PubMed, The Cochrane Library (Issue 5, 2015), EMbase, CNKI, VIP and WanFang Data from inception to August 2015, to identify studies involving healthrelated QOL about different diseases in China. A descriptive analysis was used to analyze health utility by disease and the proportion of patients who having problem in five dimensions, as well as comparing health-related QOL in different diseases. ResultsA total of 26 studies were included, involving 15 kinds of diseases. The health utility in different studies about the same disease was different. Diabetes ranged from 0.79 to 0.94, liver disease infected by HBV was from 0 to 0.80, hypertension was from 0.78 to 0.93, coronary heart disease was from 0.75 to 0.90, and chronic obstructive pulmonary disease was from 0.64 to 0.73. After ranking the health utility of fifteen kinds of diseases, the utility of kashin-beck disease and rheumatoid arthritis were 0.45 and 0.56, respectively, and the utility of children cerebral palsy was 0.44, which was the lowest. "Pain/discomfort" was the dimension with highest proportion of patients who having problem for most diseases while atrial fibrillation and children cerebral palsy were the "Self-care" and "Usual Activities". ConclusionEQ-5D is widely used in health-related QOL studies among different diseases in China. Many factors including sample source, severity of disease, complication and value set have influence on the measurement results of health utility.
Objective To evaluate the cost effectiveness of four different mechanisms clinical commonly used antidepressants, namely, amitriptyline, escitalopram, mirtazapine and venlafaxine in the treatment of moderate-severe depressive disorder in China and to provide clinicians with some advice. Methods We carried out the cost-effectiveness analysis of four antidepressants by establishing a decision tree model. The parameters uncertainty in the model was estimated through one-way sensitivity analysis. Results In terms of average cost-effectiveness ratio (CER), amitriptyline’s was 45.24 RMB, which was the lowest. And the CERs of mirtazapine, escitalopram and venlafaxine were 273.71 RMB, 332.00 RMB and 716.58 RMB, respectively. While in terms of incremental cost-effectiveness ratio (ICER), venlafaxine was excluded as the dominated strategy. When the threshold value of willingness to pay (WTP) was less than 3 420.92 RMB, amitriptyline was the most cost-effective; when the threshold value ranges between 3 420.92 RMB and 4 200 RMB, mirtazapine was the most cost-effective; and when the threshold value was over 4 200 RMB, escitalopram was the most cost-effective. In the one-way sensitivity analysis, when we changed the four kinds of drugs costs within a certain range, the results was not changed with the change of venlafaxine’s cost but changed with the other three drugs costs. Conclusion Clinicians may choose the most cost-effective therapy according to patients’ different WTP values. We suggests that health care institutions should encourage the use of escitalopram clinically and provide subsidies for patients so as to increase the overall society benefit.