{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:18:24Z","timestamp":1787894304581,"version":"build-2784847793"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In China, many patients with type 2 diabetes mellitus (T2DM) face high cardiovascular risk and a heavy disease burden. Loxenatide, a once-weekly GLP-1 receptor agonist developed in China, is now listed for reimbursement, but evidence on its long-term cost-effectiveness is limited. The FIGHTING-2 study, presented at the 2026 ECIM, provided the first direct comparison of cardiovascular outcomes between loxenatide and a DPP-4 inhibitor (sitagliptin) in Chinese T2DM patients at high cardiovascular risk and supplied core efficacy parameters for this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Assess the long-term cost-utility of loxenatide (0.2\u202fmg once weekly) versus sitagliptin (100\u202fmg once daily) in high cardiovascular risk type 2 diabetes patients in China inadequately controlled with metformin, from the healthcare system perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A five-state Markov model (event-free, myocardial infarction, stroke, heart failure, and death) was developed to simulate the natural disease progression of patients with type 2 diabetes at high cardiovascular risk. The model used a 1-year\u202fcycle length over a 40-year time horizon. Transition probabilities were estimated using the UKPDS 82 risk equations, and clinical efficacy inputs were obtained from the FIGHTING-2 study. Cost and utility parameters were derived from Chinese local literature and the National Reimbursement Drug List. The willingness-to-pay threshold was set at three times China\u2019s per capita GDP in 2025 (299,100 CNY per QALY), and both costs and health outcomes were discounted at an annual rate of 5%. The incremental cost-effectiveness ratio (ICER) was calculated in the base-case analysis. One-way and probabilistic sensitivity analyses (1,000 Monte Carlo simulations) were conducted to assess the robustness of the results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the base-case analysis, loxenatide showed an ICER of 82058.77 CNY per QALY compared with sitagliptin, which is well below the willingness-to-pay threshold (299,100 CNY per QALY). One-way sensitivity analysis showed that the ICER was most affected by the hazard ratio for heart failure and by loxenatide cost, but loxenatide remained cost-effective across all scenarios. Probabilistic sensitivity analysis indicated loxenatide was cost-effective in 100% of simulations and consistently generated additional QALYs, demonstrating robust model results. The scenario analysis also confirmed the robustness of the model results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Loxenatide has a clear cost-utility advantage over sitagliptin in the treatment of Chinese patients with type 2 diabetes at high cardiovascular risk. These findings provide high-quality evidence to support clinical standardization, rational drug use, reimbursement policy decisions, and optimal allocation of healthcare resources for this patient population in China.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1929706","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T04:32:39Z","timestamp":1787891559000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-utility analysis of loxenatide versus DPP-4 inhibitors in Chinese patients with type 2 diabetes at high cardiovascular risk"],"prefix":"10.3389","volume":"14","author":[{"given":"Longbing","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengning","family":"Chuan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuhong","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuan","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruobei","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianjuan","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Business Administration, Shenyang Pharmaceutical University","place":["Shenyang, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangang","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Chongqing Municipal Key Clinical Specialty, Chongqing University FuLing Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref1","year":""},{"key":"ref2","doi-asserted-by":"publisher","first-page":"S144","DOI":"10.2337\/dc22-S010","article-title":"10. 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