Diabetes-related Medical Costs Research Articles

Reduction in Diabetes-Related Hospitalizations and Medical Costs After Dexcom G6 Continuous Glucose Monitor Initiation in People with Type 2 Diabetes Using Intensive Insulin Therapy.

Some people with type 2 diabetes (T2D) require intensive insulin therapy to manage their diabetes. This can increase the risk of diabetes-related hospitalizations. We hypothesize that initiation of real-time continuous glucose monitoring (RT-CGM), which continuously measures a user's glucose values and provides threshold- and trend-based alerts, will reduce diabetes-related emergency department (ED) and inpatient hospitalizations and concomitant costs. A retrospective analysis of US healthcare claims data using Optum's de-identified Clinformatics® Data Mart database was performed. The cohort consisted of commercially insured, CGM-naïve individuals with T2D who initiated Dexcom G6 RT-CGM system between August 1, 2018, and March 31, 2021. Twelve months of continuous health plan enrollment before and after RT-CGM initiation was required to capture baseline and follow-up rates of diabetes-related hospitalizations and associated healthcare resource utilization (HCRU) costs. Analyses were performed for claims with a diabetes-related diagnosis code in either (1) any position or (2) first or second position on the claim. A total of 790 individuals met the inclusion criteria. The average age was 52.8 (10.5) [mean (SD)], 53.3% were male, and 76.3% were white. For claims with a diabetes-related diagnosis code in any position, the number of individuals with ≥ 1 ED visit decreased by 30.0% (p = 0.01) and with ≥ 1 inpatient visit decreased by 41.5% (p < 0.0001). The number of diabetes-related visits and average number of visits per person similarly decreased by at least 31.4%. Larger relative decreases were observed for claims with a diabetes-related diagnosis code in the first or second position on the claim. Total diabetes-related costs expressed as per-person-per-month (PPPM) decreased by $341 PPPM for any position and $330 PPPM for first or second position. Initiation of Dexcom G6 among people with T2D using intensive insulin therapy was associated with a significant reduction in diabetes-related ED and inpatient visits and related HCRU costs. Expanded use of RT-CGM could augment these benefits and result in further cost reductions.

Glycemic and Economic Outcomes in Elderly Patients with Type2 Diabetes Initiating Dulaglutide Versus Basal Insulin in a Real-World Setting in the United States: The DISPEL-Advance Study.

Treatments like glucagon-like peptide-1 receptor agonists carry low hypoglycemia risk and are recommended for elderly patients with type2 diabetes (T2D), while some routine treatments, like insulin, increase hypoglycemia risk. The DISPEL-Advance (Dulaglutide vs Basal InSulin in Injection Naïve Patients with Type2 Diabetes: Effectiveness in ReaL World) study compared glycemic outcomes, healthcare resource utilization, and costs in elderly patients with T2D who initiated treatment with dulaglutide versus those initiating treatment with basal insulin. This observational, retrospective cohort study used data from the Optum Research Database. Medicare Advantage patients (≥ 65years) with T2D were assigned to dulaglutide or basal insulin cohorts based on pharmacy claims and propensity score matched on demographic and baseline characteristics. Change in HbA1c, 12-months follow-up HbA1c, and follow-up all-cause and diabetes-related healthcare resource utilization and costs were compared. Propensity score matching yielded well-balanced cohorts with 1891 patients each (mean age: dulaglutide, 72.09years; basal insulin, 72.56years). The dulaglutide cohort had significantly greater mean HbA1c reduction from baseline to follow-up than basal insulin cohort (- 0.95% vs - 0.69%; p < 0.001). The dulaglutide cohort had significantly lower mean all-cause and diabetes-related medical costs (all-cause: $8306 vs $12,176; diabetes-related: $4681 vs $7582 respectively; p < 0.001) and lower mean all-cause total costs ($18,646 vs $20,972, respectively; p = 0.007) than basal insulin cohort. The dulaglutide cohort had significantly lower all-cause and diabetes-related total costs per 1% change in HbA1c than basal insulin cohort (all-cause: $19,729 vs $30,334; diabetes-related: $12,842 vs $17,288, respectively; p < 0.001). Elderly patients with T2D initiating dulaglutide had greater HbA1c reduction, lower mean all-cause medical and total costs, lower diabetes-related medical costs, and lower total all-cause and diabetes-related costs per 1% change in HbA1c than patients initiating basal insulin. Future studies assessing medications that do not increase hypoglycemia risk could help inform therapeutic strategies in elderly patients.

991-P: Reduction in Diabetes-Related Hospitalizations and Medical Costs after Real-Time Continuous Glucose Monitor (rtCGM) Initiation in Patients with Type 2 Diabetes (PWT2D) on Intensive Insulin Therapy (IIT)

This study evaluated changes in diabetes-related hospitalizations and healthcare resource utilization (HCRU) costs after rtCGM initiation in PWT2D on IIT. Retrospective analysis of US healthcare claims data using Optum’s Clinformatics® database was conducted. The cohort included CGM naïve PWT2D on IIT who initiated rtCGM (Dexcom G6) between 8/1/2018 through 3/31/2021 (index date=earliest observed pharmacy claim). Diabetes-related (e.g., diabetic ketoacidosis, hyperglycemia and hypoglycemia) hospitalizations (ER and inpatient visits) and associated HCRU costs were assessed 12-months pre- and post-index. Hospitalizations were expressed as changes in the number of visits. Changes in diabetes-related HCRU costs were reported as per-person-per-month (PPPM) costs. Hospitalizations and HCRU costs were defined as claims with a diabetes-related diagnosis code in the 1st or 2nd position on the claim. A total of 790 PWT2D (average age=52.8 (sd=10.5) years, 46.7% female) rtCGM users on IIT with commercial health insurance met inclusion criteria. A 50% reduction (p&amp;lt;0.0001) in the number of diabetes-related inpatient visits after rtCGM initiation was observed (baseline n=132, follow-up n=66). Similarly, after rtCGM initiation, a 47% reduction (p&amp;lt;0.05) in the number of diabetes-related ER visits occurred (baseline n=85, follow up n=45). Average PPPM diabetes-related hospitalization medical costs decreased by $329.53 (p&amp;lt;0.05). HCRU cost reductions were driven by reduced diabetes-related inpatient medical costs (-$308.46 PPPM). Payer claims showed that hyperglycemia and ketoacidosis were the most common reasons for hospitalizations 12-months pre- and post-device initiation. Findings suggest that rtCGM initiation may contribute to reduced HCRU for PWT2D on IIT by way of improving glycemic control. Disclosure K.Hannah: Employee; Dexcom, Inc. P.Nemlekar: Employee; Dexcom, Inc. G.J.Norman: Employee; Dexcom, Inc. Funding Dexcom, Inc.

Hospital-Care Utilization and Medical Cost Patterns Among Patients With Insulin-Dependent Diabetes

ObjectiveUsing claims data from an integrated payer–provider, we compared costs incurred by patients with insulin-dependent diabetes mellitus (IDDM) who received Hospital Inpatient/Observation/EmeRgency Department care (HIghER care) for diabetes-related events with those who did not receive such care to identify a target population for interventions in future studies. MethodsA retrospective study pooled real-world claims data for IDDM (type 1 or type 2) between July 1, 2018, and June 30, 2019. Medical claims were used to calculate the total and diabetes-related allowed medical costs to the enterprise and per member per month costs. ResultsMedical and prescription drug coverage from 19 378 members was analyzed. Only 8.4% of the IDDM population received HIghER care but incurred 20% of medical expenses and nearly 40% of diabetes-related medical costs. For HIghER care patients, medical spending was higher in every inpatient and outpatient category (Wilcoxon 2-sample tests, all P < .0001). Non–diabetes-related prescription drug costs were greater in this group (Wilcoxon test, Z = 2.2879, P = .0221), whereas diabetes-related prescription drug costs were higher for non-HIghER care (Wilcoxon test, Z = −9.5918, P < .0001). In a longitudinal study of 29 602 patients over 24 months, previous-year receipt of HIghER care was a significant predictor of HIghER care the subsequent year (odds ratio, 3.28). ConclusionMedical spending for patients receiving HIghER care was disproportionately high and greater in every inpatient and outpatient category. HIghER care receipt the previous year was highly predictive of HIghER care episodes the following year.

128-OR: Income-Related Disparities in Medical Expenditures in U.S. Adults with Diabetes

Relatively little is known about diabetes-related medical costs across income groups, yet such information can assist efforts to reduce income-related diabetes disparities. Using data from the 2017-20 Medical Expenditure Panel Survey, we estimated medical expenditures (total and by service category [inpatient, outpatient, and drug]) in adults with diabetes, overall and by income level (&amp;lt;125% of federal poverty level (FPL) , ≥125% and &amp;lt;200% FPL, ≥200% and &amp;lt;400% FPL, ≥400% FPL) . We also identified factors that contribute to the differences (education, health insurance, marital status, physical and mental health) by constructing a concentration index (CI) (an inequality measure with values ranging from -1 to 1 with 0 indicating no disparity) and conducting a decomposition analysis which quantifies the contribution to CI by factor. We estimated crude and adjusted medical expenditures by income group, controlling for age, sex, and race/ethnicity. All expenditures were adjusted to 20 US dollars. Persons with incomes &amp;lt;125% FPL had significantly higher health medical expenditures in total and across all service categories than the other three income groups (P&amp;lt;0.05) . After adjustments, the lowest income group spent $2828 more per person per year than the other three income groups (P&amp;lt;0.05) while no significant differences in expenditures were found among the other three groups. The estimated CI value was -0.022, indicating expenditures more concentrated in the lower income group About a half (49.1%) of the disparity was explained by higher public insurance coverage (28.6%) and poorer physical (13.3%) and mental (7.2%) health status. Diabetes-related medical expenditures are disproportionately concentrated among low-income group. Improving physical and mental health for low-income populations may help to reduce the disparity in medical expenditures of diabetes. Disclosure Y.Wang: None. H.Shao: Board Member; BRAVO4HEALTH, LLC. G.Imperatore: None. C.S.Holliday: None. P.Zhang: None.

Association Between Real-Time Continuous Glucose Monitor Use and Diabetes-Related Medical Costs for Patients with Type 2 Diabetes.

Little is known about the impact of real-time continuous glucose monitoring (rtCGM) on diabetes-related medical costs within the type 2 diabetes (T2D) population. A retrospective analysis of administrative claims data from the Optum Research Database was conducted. Changes in diabetes-related health care resource utilization costs were expressed as per-patient-per-month (PPPM) costs. A total of 571 T2D patients (90% insulin treated) met study inclusion criteria. Average PPPM for diabetes-related medical costs decreased by -$424 (95% confidence interval [CI] -$816 to -$31, P = 0.035) after initiating rtCGM. These reductions were driven, in part, by reductions in diabetes-related inpatient medical costs: -$358 (95% CI -$706 to -$10, P = 0.044). Inpatient hospital admissions were reduced on average -0.006 PPPM (P = 0.057) and total hospital days were reduced an average of -0.042 PPPM (P = 0.139). These findings provide real-world evidence that rtCGM use was associated with diabetes-related health care resource utilization cost reductions in patients with T2D.

66-LB: Real-Time Continuous Glucose Monitor (RTCGM) Use Associated with Decreased Diabetes Medical Costs for Patients with Type 2 Diabetes (T2D)

Background: RtCGM allows patients with type 2 diabetes to improve blood glucose control and reduce risk of serious acute and chronic complications of diabetes through continuous monitoring of real-time glucose levels, however little is known about the impact of rtCGM on diabetes-related medical costs in this population. Methods: A retrospective analysis of administrative claims data from the Optum Research Database was conducted. The T2D cohort included those on intensive insulin therapy (IIT), and non-intensive therapies, including basal insulin only, and non-insulin medications. Patients initiated treatment with rtCGM between October 1, 2017 and February 28, 2019 (index date= earliest observed pharmacy claim). Continuous health plan enrollment of 12 months prior to, and 6 months after index date was required. Individuals with evidence of pregnancy, or type 1 diabetes were excluded. Total diabetes-related medical costs were assessed during the pre-and post-index periods and expressed as change in per-person-per-month (PPPM) costs. Results: A total of 571 T2D patients met study inclusion criteria (average age = 51.2 (sd = 11.9) years, 46% female, 80% IIT). Average PPPM diabetes-related medical costs decreased by -$424, 95% CI -$816, -$31, p&amp;lt;0.035 after initiating rtCGM treatment (pre-index mean (SD) PPPM costs: $1,680 ($4,519); post-index: $1,256 ($3,679)). These reductions were driven, in part, by reductions in diabetes-related inpatient medical costs (-$358, 95% CI -$706, -10. p&amp;lt;.-044). Inpatient hospital stays were reduced on average -.006 PPPM and hospital days were reduced an average of -.042 PPPM. Conclusions: These findings provide real-world evidence that rtCGM use was associated with diabetes-related medical cost reductions in patients with T2D. Increased access to rtCGM for patients with T2D may help to reduce diabetes-related cost of care. Disclosure G. J. Norman: Employee; Self; Dexcom, Inc. M. L. Paudel: None. T. Bancroft: None. P. M. Lynch: Employee; Self; Dexcom, Inc.

140-OR: Projected Impact of the Medicare Part D Senior Savings Model (SSM) on Diabetes-Related Health and Economic Outcomes among Insulin Users Covered by Medicare

CMS announced the Medicare Part D SSM to lower out-of-pocket costs for insulin. This study aimed to estimate the impacts of the SSM on clinical and economic outcomes among Medicare insulin users. We used the 2015-2016 National Health and Nutrition Examination Survey to generate a nationally representative simulation sample. We used the Building, Relating, Validating, Assessing, Outcomes (BRAVO™) Diabetes microsimulation model to simulate the impact of the SSM on diabetes-related complications, quality-adjusted life-years (QALYs), and medical costs. We used 30% rebate rate for Medicare insulin payment. 1.29 million insulin users covered by Medicare enhanced health plans are projected to be eligible for SSM in 2021. The SSM associated risk reductions in complications were reported in the Table. Over 5 years, the SSM is projected to increase $2.0 billion medical cost ($1,573/person) with a gain of 7,750 (0.01/person) QALYs (Incremental cost-effectiveness ratio (ICER): $157,300/QALY). In 20 years, the SSM will incur an additional $4.5 billion medical cost ($3474/person) with an increased QALYs of 72,095 (0.06/person, ICER=$57,900/QALY). Because the SSM was projected to increase medical costs for diabetes, this policy would have to be in place for longer than the 5-year period (as currently planned), or further reduce Medicare payment on insulin. Disclosure H. Shao: Research Support; Self; Sanofi. H. Kianmehr: None. L. Shi: Research Support; Self; AstraZeneca, Sanofi. V. Fonseca: Consultant; Self; Abbott Diabetes, Asahi Kasei Corporation, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Intarcia Therapeutics, Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Stock/Shareholder; Self; Amgen Inc., Bravo4health, Mellitus Health. J. D. Brown: None.

Persistence with Basal-Bolus Insulin Therapy in Patients with Type 2 Diabetes Mellitus and Effect on Clinical and Economic Outcomes: A Retrospective Claims Database Study.

Persistence with multiple daily insulin injections (MDI) may be challenging for patients with type 2 diabetes (T2DM). However, limited information is available regarding the effect of persistence with MDI on outcomes. To evaluate persistence with basal and bolus insulin therapy and assess its relationship with clinical and economic outcomes in a real-world setting. This retrospective matched cohort study used 2012-2015 data from multiple U.S. commercial health plans (IBM MarketScan). Patients with T2DM aged 18-64 years with ≥ 2 basal and ≥ 2 bolus insulin claims during a 12-month period were eligible for inclusion if they had 18 months of continuous health plan enrollment (6-month baseline and 12-month post-index). Persistence during 12 months post-index was defined using 2 methods: (a) method 1, ≤ 90-day gaps in both basal and bolus insulin claims and (b) method 2, ≥ 1 basal and ≥ 1 bolus insulin claim every quarter (every 90 days) for 4 consecutive quarters after index bolus claim. Propensity score matching was used to match persistent and nonpersistent method 2 cohorts. Mean per-patient all-cause and diabetes-related medical costs (2015 U.S. dollars, excluding outpatient drugs) and health care resource use (HCRU) were calculated. For patients with hemoglobin A1c (A1c) values during baseline and post-index months 10-12, treatment success was defined as (a) A1c decrease from baseline of ≥ 1% and/or (b) baseline A1c ≥ 7% with post-index A1c < 7%. Baseline characteristics of matched cohorts were compared using standardized mean differences (SMDs). Outcome variables were compared using t-tests, chi-square tests, and generalized linear models. Characteristics of 12,882 eligible patients and 12-month persistence rates were similar as defined by method 1 (22.4%) and method 2 (21.1%). After matching, the method 2 cohorts included 2,723 and 8,169 persistent and nonpersistent patients, respectively, with well-balanced baseline characteristics (mean age 53 years; 58% men; all SMDs < 0.1). All-cause annual medical costs were lower for the persistent cohort (mean $13,499 vs. $17,362; P < 0.0001), as were annual diabetes-related costs (mean $6,392 vs. $8,376; P < 0.0001). In persistent versus nonpersistent cohorts, 11% versus 15% of patients, respectively, experienced ≥ 1 hospitalization; 21% versus 24%, respectively, had ≥ 1 ED visit; 9% versus 12%, respectively, experienced ≥ 1 diabetes-related hospitalization; and 13% versus 15%, respectively, had ≥ 1 diabetes-related ED visit (P ≤ 0.005 for all). Mean baseline A1c was similar in persistent and nonpersistent cohorts (9.7% vs. 9.6%, respectively; P = 0.63). Persistence with MDI was associated with greater mean reduction in A1c (-1.3% vs. -0.8%, respectively; P = 0.006) and greater percentages of patients achieving treatment success (55% vs. 39%, respectively, for nonpersistent; P = 0.009). Poor persistence with basal-bolus insulin therapy over 12 months of follow-up was prevalent and was associated with greater medical costs, greater HCRU, and poorer glycemic control than for patients who were persistent. Interventions are needed to improve persistence with insulin therapy and aid patients with T2DM to achieve glycemic control. Funding for this study was provided by Becton, Dickinson and Company (BD). All authors except Edelman are employees and stockholders of BD. Edelman reports board membership at Senseonics and participation in advisory board/speakers bureau at Lilly USA, MannKind, Novo Nordisk, Sanofi-Aventis U.S., Merck, and AstraZeneca, all unrelated to this study. A poster for this study was presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2018; April 23-26, 2018; Boston MA.

PDB57 REAL-WORLD ECONOMIC OUTCOMES AMONG PATIENTS WITH TYPE 2 DIABETES (T2D) TREATED WITH DULAGLUTIDE (DU) VS. BASAL INSULIN (BI) IN THE US: THE DISPELTM STUDY

To report 1-year economic outcomes from the retrospective Dulaglutide vs. Basal InSulin in Injection Naïve Patients with Type 2 Diabetes: Effectiveness in ReaL World (DISPEL) study. The HealthCore Integrated Research Database (HIRD®) was used to identify patients with T2D initiating DU or BI between 11/01/2014 and 04/30/2017 (index date=earliest fill date). Patients ≥18 years, with no claim for any antidiabetic injectable in the 6 months pre-index period (baseline), continuous enrollment and ≥1 HbA1c result at baseline and 1-year post-index were included. DU initiators were propensity-matched 1:1 to BI initiators. Mean diabetes-related medical, pharmacy and total healthcare costs during the 1-year post-index period were compared between the matched cohorts using generalized linear models. Mean costs per 1% HbA1c reduction were compared using bootstrap. Costs were adjusted to 2017 US dollars. The matched cohorts with 523 DU:BI pairs were well-balanced on baseline characteristics including healthcare costs. Mean age was 54 years and approximately 51% were males. At 1-year post-index, DU initiators had higher diabetes-related pharmacy costs (mean±SD: $9,809±$5,235 vs. $6,175±$5,231, p<0.01), lower diabetes-related medical costs ($3,753±$9,111 vs. $7,604±$24,234, p<0.01) and similar diabetes-related total costs ($13,562±$10,261 vs. $13,779±$24,728, p=0.76) compared to BI initiators. DU initiators achieved greater HbA1c reduction [-1.2 (1.53) vs. -0.6 (1.85), p<0.01]. The mean (±bootstrap SE) diabetes-related medical and total costs per 1% HbA1c reduction were lower for DU initiators than BI initiators (medical: $3,128±$399 vs. $12,673±$2,825, p<0.01; total: $11,302±$752 vs. $22,965±$4,125, p<0.01), while pharmacy costs per 1% HbA1c reduction were lower without reaching statistical significance ($8,174±$504 vs. $10,292 ±$1,768, p=0.15). Although there was no significant difference in the total diabetes-related cost between the two cohorts at 1-year follow up, the total cost per HbA1c reduction was lower for DU vs. BI initiators, highlighting the importance of evaluating effectiveness along with the economic impact of medications.

The association between the severity of chronic kidney disease and medical costs among patients with type 2 diabetes

Aims: Examine healthcare costs across chronic kidney disease (CKD) stages for US patients with type 2 diabetes (T2D).Materials and methods: IQVIA Real World Data Adjudicated Claims linked electronic medical records and insurance claims from January 1, 2012 through March 31, 2017 were used for this retrospective study. Adults diagnosed with T2D and comorbid CKD were included. General linear models incorporating splines were constructed, and information from these regressions were used to inform the relationship between medical costs and CKD. Multivariable analyses controlled for patient characteristics, vital signs, general health, prior medication use, prior visit to specialists, index A1c, and year of index date.Results: There were 6,645 individuals who met the study criteria. Results generally indicate sharp increases in annual total medical costs and non-drug medical costs in the 1 year post-period for patients with Stage 4 or 5 CKD (estimated glomerular filtration rate [eGFR] ≤ 30 mL/min/1.73 m2) with each 1 point reduction in eGFR from 30 associated with an increase of $1,870 in all-cause total medical costs (p < 0.0001) and $1,805 of all-cause non-drug medical costs (p < 0.0001). Similarly, each point decline below 30 mL/min was associated annual cost increases of $1,701 for CKD-related total medical costs, $1,695 for CKD-related non-drug medical costs, $173 for diabetes-related medical costs, and $187 for diabetes-related non-drug medical costs (all p < 0.0001).Limitations: The investigation included only patients with medical insurance and laboratory test results, and results may not be generalizable to all T2D patients with CKD. The methodology allowed us to determine associations, not causation, and potential confounders, such as duration of diabetes, diet, exercise, or social support, could not be assessed.Conclusions: Results indicate there are sharp and significant increases in medical costs among T2D patients with Stage 4 and 5 CKD compared to those with earlier stages of CKD.

PDB47 - THE ASSOCIATION BETWEEN RENAL FUNCTION AND HEALTHCARE COSTS IN US PATIENTS WITH TYPE 2 DIABETES

Examine healthcare costs for US patients with type 2 diabetes (T2D) and comorbid chronic kidney disease (CKD) IQVIA linked claims and medical records from January 1, 2012 through March 31, 2017 were used for this retrospective study. Patients age 18 and older, diagnosed with T2D, and identified with CKD were included. Patients with type 1 diabetes, pregnancy, or without continuous insurance coverage from the date first identified with CKD (the index date) through the 1-year post-period were excluded from the study. General linear models incorporating splines were constructed and information from these regressions were used to inform whether the relationship between costs and CKD would best be captured by incorporating non-linearities. These models also controlled for patient characteristics, vital signs, general health, prior medication use, prior visit to specialists, index A1c, and year of index date. There were 6,645 individuals who fit the study inclusion and exclusion criteria – 3,189 with Stage 1 or 2 CKD, 1,441 in Stage 3a, 1,184 in Stage 3b, 449 in Stage 4 and 382 in Stage 5. Results generally indicate sharp increases in total medical costs and non-drug medical costs for patients with Stage 4 or 5 CKD (estimated glomerular filtration rate [eGFR] ≤ 30 mL/min/1.73m2) with each 1 point reduction in eGFR from 30 associated with an increase of $1,870 in all-cause total medical costs (P<0.0001) and $1,805 of all-cause non-drug costs (P<0.0001). Similarly, each point decline below 30 mL/min was associated annual costs increases of $1,701 for CKD-related total medical costs, $1,695 for CKD-related non-drug costs, $174 for diabetes-related medical costs, and $187 for diabetes-related non-drug costs (all P<0.0001). Results indicate there are sharp and significant increases in medical costs among T2D patients with Stage 4 and 5 CKD compared to those with earlier stages of CKD.

A Retrospective Cohort Study of Patients with Type 2 Diabetes in China: Associations of Hypoglycemia with Health Care Resource Utilization and Associated Costs.

IntroductionThis study aimed to examine the associations of hypoglycemia with health care resource utilization (HCRU) and health care costs among patients with type 2 diabetes mellitus (T2DM) in China.MethodsThis retrospective cohort study was conducted with 23,680 T2DM patients >18 years old who visited the Second Affiliated Hospital of Nanchang University between 1 January 2011 and 31 December 2015. Univariate descriptive statistics were used to relate the HCRU and associated costs to patient characteristics, and regression analysis was used to examine the association between hypoglycemia and HCRU, controlling for other confounding factors.ResultsIn the T2DM patients with or without insulin treatment, when compared with nonhypoglycemic patients, hypoglycemia was associated with more medical visits (all T2DM patients 19.48 vs. 10.46, insulin users 23.45 vs. 14.12) and higher diabetes-related medical costs (all T2DM patients ¥5187.54 vs. ¥3525.00, insulin users ¥6948.84 vs. ¥3401.15) and medication costs (T2DM patients ¥1349.40 vs. ¥641.92, insulin users: ¥1363.87 vs. ¥853.96). Controlling for age, gender, and Charlson comorbidity index (CCI) score, hypoglycemia and insulin intake were associated with greater health care resource utilization. As compared to nonhypoglycemic patients, hypoglycemic T2DM patients and those on insulin therapy performed more outpatient visits (proportions of hypoglycemic vs nonhypoglycemic T2DM patients performing 3+ visits: 72.69% vs. 65.49%; proportions of hypoglycemic vs nonhypoglycemic patients on insulin therapy performing 3+ visits: 78.26% vs. 71.73%) and were hospitalized more often (proportions of hypoglycemic vs nonhypoglycemic T2DM patients with 3+ admissions 75.90% vs. 50.24%; proportions of hypoglycemic vs nonhypoglycemic patients on insulin therapy with 3+ admissions: 83.19% vs. 58.51%).ConclusionHypoglycemia in diabetes patients was associated with increased healthcare resource utilization and health-related expenditure, especially for patients on insulin treatment. Insulin treatment regimens should be more individualized and account for hypoglycemia risk.

Healthcare costs among adults with type 2 diabetes initiating saxagliptin or linagliptin: a US-based claims analysis

Objective: To compare healthcare costs of adults with type 2 diabetes (T2D) after initiation of saxagliptin or linagliptin, two antidiabetic medications in the dipeptidyl peptidase-4 inhibitor medication class.Methods: Patients with T2D who were at least 18 years old and initiated saxagliptin or linagliptin (index date) between 1 June 2011 and 30 June 2014 were identified in the MarketScan Commercial and Medicare Supplemental Databases. All-cause healthcare costs and diabetes-related costs (T2D diagnosis on a medical claim and/or an antidiabetic medication claim) were measured in the 1 year follow-up period. Saxagliptin and linagliptin initiators were matched using propensity score methods. Cost ratios (CRs) and predicted costs were estimated from generalized linear models and recycled predictions.Results: There were 34,560 saxagliptin initiators and 18,175 linagliptin initiators identified (mean ages 57 and 59; 55% and 56% male, respectively). Before matching, saxagliptin initiators had significantly lower all-cause total healthcare costs than linagliptin initiators (mean = $15,335 [SD $28,923] vs. mean = $20,069 [SD $48,541], p < .001) and significantly lower diabetes-related total healthcare costs (mean = $6109 [SD $13,851] vs. mean = $7393 [SD $26,041], p < .001). In matched analyses (n = 16,069 per cohort), saxagliptin initiators had lower all-cause follow-up costs than linagliptin initiators (CR = 0.953, 95% CI = 0.932–0.974, p < .001; predicted costs = $17,211 vs. $18,068). There was no significant difference in diabetes-related total costs after matching; however, diabetes-related medical costs were significantly lower for saxagliptin initiators (CR = 0.959, 95% CI = 0.927–0.993, p = 0.017; predicted costs = $3989 vs. $4159).Conclusions: Adult patients with T2D initiating treatment with saxagliptin had lower total all-cause healthcare costs and diabetes-related medical costs over 1 year compared with patients initiating treatment with linagliptin.

Economic Impact of Treatment Duration and Persistence with Basal Insulin in Previously Insulin-Naive Users.

Although insulin is a well-established therapy that is associated with improved clinical outcomes, adherence and persistence with insulin regimens are poor in patients with type 2 diabetes mellitus (T2DM). Diabetes-related health care costs and the impact of insulin persistence patterns on these health care costs have been previously studied; however, these aspects of insulin therapy have limited data beyond the first year of use and have not been characterized among patients previously naive to basal insulin. To (a) describe and compare medical- and pharmacy-related costs, health care resource utilization, and comorbidities and complications during the initial year and second (experienced) year of basal insulin therapy, and (b) describe and compare the impact of continuous versus interrupted basal insulin use during each year. This was a retrospective observational database analysis using claims from multiple U.S. commercial health plans (Truven Health MarketScan) in previously insulin-naive patients with T2DM who were initiated on basal insulin. Data collected included all-cause and diabetes-related medical and pharmacy costs, health care resource utilization (i.e., number and type of outpatient visits, hospitalization, emergency department [ED] visits), medication use, and preselected comorbidities and complications. This cost analysis described and compared health care costs and resource use between the initial and experienced years and further compared health care costs and resource use between continuers and interrupters within each of those years. A total of 23,645 patients were included in the analysis; 12,224 were classified as continuers and 11,421 were classified as interrupters. Among all patients, mean increases from the initial year to the experienced year were observed for all-cause medical costs ($12,690-$13,408; P = 0.048), all-cause pharmacy costs ($6,253-$6,559; P < 0.001), and all-cause health care costs ($18,943-$19,967; P = 0.006), after adjusting for inflation. All-cause pharmacy costs were significantly higher for continuers versus interrupters, but total diabetes-related medical care costs, all-cause ED costs, and all-cause medical costs were significantly lower, resulting in similar all-cause health care costs between continuers and interrupters in both the initial and experienced years. Among all patients, diabetes-related inpatient visits and outpatient primary care physician (PCP) visits, total medical inpatient visits, and total medical outpatient PCP visits were significantly higher in the initial year than in the experienced year; however, there were fewer diabetes-related ED visits in the initial year. Initiation of basal insulin appears to be associated with increased health care costs, and treatment persistence pattern (continuers vs. interrupters) is further correlated with health care expenditures. Although associated with decreased pharmacy costs, interruption of therapy increases medical costs, underscoring the importance of addressing persistence to therapy. This study was funded by Eli Lilly and Company and Boehringer Ingelheim. Eli Lilly reviewed and approved this manuscript for submission. All the authors are employees and minor shareholders of Eli Lilly and Company. Study concept and design were contributed by Kalirai, Duan, and Reed. Duan and Liu collected the data, and data interpretation was performed by Kalirai. The manuscript was written by all the authors and revised by Kalirai.

Associations between adherence and outcomes among older, type 2 diabetes patients: evidence from a Medicare Supplemental database.

ObjectiveTo examine the association between adherence to glucose-lowering agents and patient outcomes, including costs, acute-care resource utilization, and complications, in an older, type 2 diabetic population.Data and methodsThe study used Truven’s Medicare Supplemental database from July 1, 2009 to June 30, 2014. Patients aged 65 years or older were included if they had at least two type 2 diabetes diagnoses and received a glucose-lowering agent from July 1, 2010 through June 30, 2011. Multivariable analyses examined the relationships among 3-year patient outcomes and levels of adherence, proxied by the proportion of days covered. Outcomes included all-cause medical costs, diabetes-related medical costs, acute-care resource utilization, and acute complications.ResultsIn this study (N=123,235), higher adherence was linked to reduced costs and improved health outcomes. For example, comparing an individual with adherence of proportion of days covered <20% to one with proportion of days covered ≥80% illustrates an average saving of $28,824 in total 3-year costs. Furthermore, a 1% increase in adherence among 1,000 patients was associated with all-cause savings of $65,464 over 3 years. The probability of a hospitalization, an emergency room (ER) visit, or an acute complication decreased monotonically as adherence levels got higher, as did the number of hospitalizations, ER visits, and days hospitalized (P<0.005).ConclusionHigher adherence was associated with substantially less need for acute care, as indicated by a lowered probability of hospitalization or ER use, a reduced risk of an acute complication, and a decreased number of hospitalizations, ER visits, and days hospitalized. Higher adherence was also generally associated with lower all-cause and diabetes-related total costs, despite higher drug costs. These lower total costs were driven by the diminished acute care and outpatient costs. Results suggest that higher glucose-lowering agent adherence is associated with significant benefits for payers and older patients with type 2 diabetes.

Medication usage, treatment intensification, and medical cost in patients with type 2 diabetes: a retrospective database study

ObjectiveThe goal of this study was to describe medication usage patterns in patients with type 2 diabetes mellitus (T2DM) initiating treatment with non-insulin antidiabetic drugs (NIADs), basal insulin, or prandial/mixed...

Current and future economic burden of diabetes among working-age adults in Asia: conservative estimates for Singapore from 2010-2050.

BackgroundDiabetes not only imposes a huge health burden but also a large economic burden worldwide. In the working-age population, cost of lost productivity can far exceed diabetes-related medical cost. In this study, we aimed to estimate the current and future indirect and excess direct costs of diagnosed type 2 diabetes among the working-age population in Singapore.MethodsA previously-published epidemiological model of diabetes was adapted to forecast prevalence among working-age patients with diagnosed type 2 diabetes in the absence of interventions. The current methodology of the American Diabetes Association was adopted to estimate the costs of diabetes for this population. Diabetes-related excess direct medical costs were obtained from a local cost study while indirect costs were calculated using the human capital approach applied to local labor force statistics. These cost were estimated conservatively from a societal perspective on a per patient basis and projected to the overall Singapore population from 2010 to 2050.ResultsIn 2010, total economic costs per working-age patient were estimated to be US$5,646 (US$4,432-US$10,612), of which 42 % were excess direct medical costs and 58 % indirect productivity-related losses. Total cost is projected to rise to US$7,791 (US$5,741-US$12,756) in 2050, with the share of indirect costs rising to 65 %. Simultaneous increases in prevalence imply that the total economic costs of diabetes for the entire working-age population will increase by 2.4 fold from US$787 million in 2010 to US$1,867 million in 2050.ConclusionsBy current projections, diabetes in Singapore represents a growing economic burden. Among the working-age population, the impact of productivity loss will become increasingly significant. Prevention efforts to reduce overall prevalence should also engage stakeholders outside the health sector who ultimately bear the indirect burden of disease.

Healthcare Costs Among Adults with Type 2 Diabetes Initiating DPP-4 Inhibitors.

IntroductionOral antidiabetes medications, including dipeptidyl peptidase-4 inhibitors (DPP-4is) saxagliptin and sitagliptin, are used for the treatment of type 2 diabetes (T2D). The study objective was to compare all-cause and diabetes-related costs following initiation of saxagliptin or sitagliptin.MethodsPatients aged ≥18 years initiating saxagliptin or sitagliptin between January 1, 2009 and January 31, 2012 in the Truven Health MarketScan Commercial and Medicare Supplemental databases were identified. Patients were required to have continuous enrollment for ≥365 days before and ≥365 days after the index date (date of the first saxagliptin or sitagliptin claim). Additionally, patients were required to have a claim with a T2D diagnosis (ICD-9-CM 250.×0, 250.×2) and no claims for a DPP-4i medication before the index date. All-cause and diabetes-related medical costs and total costs (including pharmacy costs) were captured over the 1-year follow-up period. Generalized linear models with log link and gamma distribution were fit to compare costs between the two cohorts using cost ratios, controlling for patient baseline characteristics. Recycled prediction methods were used to generate adjusted predicted costs and confidence intervals.ResultsThe final sample comprised 3354 saxagliptin initiators and 26,895 sitagliptin initiators. The average age of saxagliptin and sitagliptin initiators was 57 years and just over 50% were males. After adjusting for baseline characteristics, saxagliptin patients had significantly lower average all-cause medical costs (cost ratio = 0.901, P < 0.001; predicted mean costs: $8687 vs. $9646) compared with sitagliptin patients over the 1-year follow-up. Findings were consistent for diabetes-related medical costs (cost ratio = 0.890, P < 0.001; predicted mean costs: $2180 vs. $2450). Total costs were also lower for saxagliptin initiators (cost ratio = 0.950, P = 0.002; predicted mean costs: $13,911 vs. $14,651) over the 1-year follow-up period.ConclusionInitiation of treatment with saxagliptin was associated with lower medical costs over 1 year compared with initiation of sitagliptin among adults with T2D.FundingAstraZeneca.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0277-2) contains supplementary material, which is available to authorized users.

A retrospective study of persistence, adherence, and health economic outcomes of fixed-dose combination vs loose-dose combination of oral anti-diabetes drugs

Objective:To compare outcomes between patients with type 2 diabetes mellitus (T2DM) using fixed-dose combination (FDC) and loose-dose combination (LDC) products.Methods:This retrospective cohort study used MarketScan® Commercial and Medicare Supplemental data from January 1, 2009–December 31, 2013. The identified population included patients with T2DM and ≥1 additional oral anti-diabetic prescription (of the same regimen [FDC/LDC] as the index prescription) within 12 months following the fill date. Persistence (no ≥30-day gap) and adherence (medication possession ratio [MPR] ≥0.8) were assessed as primary end-points; secondary end-points included hypoglycemia, healthcare resource utilization, and costs.Results:Of 23,361 patients identified, 12,590 (53.9%) were on FDC therapy and 10,771 (46.1%) were on LDC therapy. FDC patients had a significantly lower rate of non-persistence (67.9% vs 73.4%, p < 0.0001) and a significantly higher rate of adherence to therapy (57.0% vs 50.7%, p < 0.0001) when compared to LDC patients. Average time to non-persistence was significantly longer among FDC vs LDC patients (207.1 vs 186.3 days, p < 0.0001). After adjusting for baseline characteristics, the odds of non-persistence were 21% lower with FDC vs LDC therapy (OR = 0.79, 95% CI = 0.74–0.85, p < 0.0001), with a 28% higher odds of adherence (OR = 1.28, 95% CI = 1.20–1.36, p < 0.0001). Differences in most secondary outcomes significantly favored FDC therapy, including total predicted monthly all-cause costs ($1008 vs $1053; p = 0.006) and T2DM-related costs ($142 vs $155; p < 0.001).Limitations:Cohort classification was based on prescription claims data. The lack of clinical data limits assessment of potential influencers of FDC vs LDC decisions, residual confounding was possible, and diabetes-related medical costs only captured claims with a primary diagnosis for diabetes. The results may not be generalizable to populations such as Medicaid.Conclusion:Management of T2DM using FDC therapies provides a compliance benefit relative to LDC therapies that may translate to reductions in healthcare utilization and costs.