{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T03:49:26Z","timestamp":1788320966334,"version":"build-2803163510"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T00:00:00Z","timestamp":1693958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To systematically estimate and compare the effectiveness and cost-effectiveness of the glucagon-like peptide-1 receptor agonists (GLP-1RAs) approved in China and to quantify the relationship between the burden of diabetic comorbidities and glycosylated hemoglobin (HbA1c) or body mass index (BMI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>To estimate the costs (US dollars, USD) and quality-adjusted life years (QALY) for six GLP-1RAs (exenatide, loxenatide, lixisenatide, dulaglutide, semaglutide, and liraglutide) combined with metformin in the treatment of patients with type 2 diabetes mellitus (T2DM) which is inadequately controlled on metformin from the Chinese healthcare system perspective, a discrete event microsimulation cost-effectiveness model based on the Chinese Hong Kong Integrated Modeling and Evaluation (CHIME) simulation model was developed. A cohort of 30,000 Chinese patients was established, and one-way sensitivity analysis and probabilistic sensitivity analysis (PSA) with 50,000 iterations were conducted considering parameter uncertainty. Scenario analysis was conducted considering the impacts of research time limits. A network meta-analysis was conducted to compare the effects of six GLP-1RAs on HbA1c, BMI, systolic blood pressure, and diastolic blood pressure. The incremental net monetary benefit (INMB) between therapies was used to evaluate the cost-effectiveness. China\u2019s <jats:italic>per capita<\/jats:italic> GDP in 2021 was used as the willingness-to-pay threshold. A generalized linear model was used to quantify the relationship between the burden of diabetic comorbidities and HbA1c or BMI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a lifetime, the cost for a patient ranged from USD 42,092 with loxenatide to USD 47,026 with liraglutide, while the QALY gained ranged from 12.50 with dulaglutide to 12.65 with loxenatide. Compared to exenatide, the INMB of each drug from highest to lowest were: loxenatide (USD 1,124), dulaglutide (USD \u22121,418), lixisenatide (USD \u22121,713), semaglutide (USD \u22124,298), and liraglutide (USD \u22124,672). Loxenatide was better than the other GLP-1RAs in the base-case analysis. Sensitivity and scenario analysis results were consistent with the base-case analysis. Overall, the price of GLP-1RAs most affected the results. Medications with effective control of HbA1c or BMI were associated with a significantly smaller disease burden (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Loxenatide combined with metformin was identified as the most economical choice, while the long-term health benefits of patients taking the six GLP-1RAs are approximate.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1201818","type":"journal-article","created":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T17:43:48Z","timestamp":1694022228000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Effectiveness and cost-effectiveness of six GLP-1RAs for treatment of Chinese type 2 diabetes mellitus patients that inadequately controlled on metformin: a micro-simulation model"],"prefix":"10.3389","volume":"11","author":[{"given":"Shuai","family":"Yuan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingyu","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2498","DOI":"10.1001\/jama.2021.22208","article-title":"Prevalence and treatment of diabetes in China, 2013\u20132018","volume":"326","author":"Wang","year":"2021","journal-title":"JAMA"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1186\/s12916-020-01837-x","article-title":"Choice across 10 pharmacologic combination strategies for type 2 diabetes: a cost-effectiveness analysis","volume":"18","author":"Gu","year":"2020","journal-title":"BMC Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1007\/s00125-017-4342-z","article-title":"The mechanisms of action of metformin","volume":"60","author":"Rena","year":"2017","journal-title":"Diabetologia"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"S98","DOI":"10.2337\/dc20-S009","article-title":"Standards of medical Care in Diabetes-2020","volume":"43","year":"2020","journal-title":"Diabetes Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1002\/dmrr.2827","article-title":"Standards of care for type 2 diabetes in China","volume":"32","author":"Weng","year":"2016","journal-title":"Diabetes Metab Res Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"D6423","DOI":"10.1002\/14651858.CD006423.pub2","article-title":"Glucagon-like peptide analogues for type 2 diabetes mellitus","volume":"2011","author":"Shyangdan","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"487","DOI":"10.2337\/dci19-0066","article-title":"A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of diabetes (EASD)","volume":"43","author":"Buse","year":"2018","journal-title":"Diabetes Care"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3760\/cma.j.cn112138-20211027-00751","article-title":"Clinical guidelines for prevention and treatment of type 2 diabetes mellitus in the elderly in China. 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