Abstract
IntroductionThe objective of this study was to compare the clinical effectiveness of liraglutide with sitagliptin and assess the associated economic outcomes in patients with type 2 diabetes mellitus (T2DM) treated in real-world practice in the United States (US).MethodsThis retrospective cohort study used a large US claims database to identify patients with T2DM who initiated liraglutide or sitagliptin between January 2010 and December 2012. Adults (≥18 years old) with persistent use of therapy for ≥3 months were included. Changes in glycated hemoglobin A1c (A1C) and the proportion of patients achieving A1C targets (≤6.5% and <7%) were examined at 6-month follow-up. Diabetes-related total, medical, and pharmacy costs over the follow-up period were assessed. Multivariable regression models were used to estimate the outcomes associated with liraglutide relative to sitagliptin, adjusting for differences in patient demographics and clinical characteristics.ResultsThe study included 1,465 patients with T2DM who initiated liraglutide (N = 376) or sitagliptin (N = 1,089) (mean age [standard deviation (SD)]: 54 [8.9] vs. 58 [10.8] years; 43.9% vs. 61.8% males; both P < 0.01). After controlling for confounding factors, liraglutide patients experienced 0.31% points greater reduction in A1C (0.95% vs. 0.63% points; P < 0.01) at 6-month follow-up than sitagliptin patients and were more likely to reach A1C targets of ≤6.5% (odds ratio [OR]: 2.00; P < 0.01) and <7% (OR: 1.55; P < 0.01). Liraglutide patients had $994 lower mean diabetes-related medical costs ($1,241 vs. $2,235; P < 0.01), but $544 higher diabetes-related pharmacy costs ($2,100 vs. $1,556; P < 0.01) during the follow-up. No difference was found in the total mean diabetes-related costs between the two cohorts.ConclusionLiraglutide showed greater improvement in glycemic outcomes than sitagliptin among adult patients with T2DM in real-world clinical practice. Although diabetes-related pharmacy costs for patients using liraglutide were higher compared with sitagliptin, these were offset by significantly lower diabetes-related medical costs, resulting in similar total diabetes-related costs between the two treatment groups.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-014-0084-9) contains supplementary material, which is available to authorized users.
Highlights
The objective of this study was to compare the clinical effectiveness of liraglutide with sitagliptin and assess the associated economic outcomes in patients with type 2 diabetes mellitus (T2DM) treated in real-world practice in the United States (US)
Liraglutide patients were younger (mean age [standard deviation (SD)]: 54 [8.9] years vs. 58 [10.8] years; P\0.01) and were less likely to be males (43.9% vs. 61.8%; P\0.01) than sitagliptin patients (Table 1)
Liraglutide patients were more likely to obtain their prescriptions from endocrinologists than sitagliptin patients (15.7% vs. 4.4%; P\0.01; Table 2)
Summary
The objective of this study was to compare the clinical effectiveness of liraglutide with sitagliptin and assess the associated economic outcomes in patients with type 2 diabetes mellitus (T2DM) treated in real-world practice in the United States (US). Incretin-based therapies for the management of T2DM are effective in lowering glycated hemoglobin A1c (A1C) with a low risk of hypoglycemia [6,7,8] These therapies, including injectable glucagon-like peptide-1 (GLP-1) receptor agonists (such as liraglutide [VictozaÒ; Novo Nordisk A/S, Bagsvaerd, Denmark]) and oral dipeptidyl peptidase-4 (DPP-4) inhibitors (such as sitagliptin [JanuviaÒ; Merck Sharp & Dohme Corp., Whitehouse Station, NJ, USA]), have different mechanisms of actions in increasing insulin secretion and decreasing glucagon secretion [9]
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