Diabetes-related Pharmacy Costs Research Articles

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.

Evaluation of patients with type 2 diabetes mellitus receiving treatment during the pre-diabetes period: Is early treatment associated with improved outcomes?

AimThis study evaluates the association of pretreatment with oral antidiabetics (OADs) on clinical outcomes and health resource utilization among commercially insured type II diabetes mellitus (T2DM) patients in the United States. MethodsUsing administrative data (Truven MarketScan® Research Databases), patients diagnosed with T2DM between 2007 and 2014 with ⩾6months continuous enrolment pre- and post-diagnosis were evaluated. Pretreatment was defined as OAD use at least 3months prior to T2DM diagnosis. Time-to-insulin initiation and healthcare costs were compared by OAD pretreatment status. ResultsOf the 866,605 patients studied, 241,856 (27.9%) were pretreated prior to T2DM diagnosis. Mean follow-up was 2.9years for pretreatment and 3.1years for those without pretreatment. Monthly diabetes-related pharmacy costs were significantly higher among pretreated patients ($66 versus $36, p<0.0001), as were overall monthly pharmacy costs ($255 versus $198, p<0.0001). Pretreated patients had lower mean monthly costs, both total ($625 versus $671, p<0.0001) and diabetes-related ($207 versus $214, p=0.0012). After multivariable adjustment, mean monthly diabetes-related total healthcare costs were higher among pretreated patients (+$60) but total all-cause monthly healthcare costs were significantly lower (−$354) (both p<0.05). Pretreatment was associated with a lower insulin initiation probability for 2years, after which probability was similar; the adjusted hazard ratio for pretreatment in a time-to-insulin model was 0.96 (95% CI, 0.94–0.97). ConclusionsPretreatment with OADs is associated with a modest delay in initiating insulin therapy and lower total healthcare costs. The clinical and pharmacoeconomic benefits of pretreatment should be elucidated in a prospective study.

Real-world clinical and economic outcomes of liraglutide versus sitagliptin in patients with type 2 diabetes mellitus in the United States.

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.

Liraglutide beats exenatide in diabetes-related pharmacy costs

Liraglutide beats exenatide in diabetes-related pharmacy costs

Real-World Cost-Effectiveness: Lower Cost of Treating Patients to Glycemic Goal with Liraglutide versus Exenatide

IntroductionWhile the liraglutide effect and action in diabetes (LEAD-6) clinical trial compared the efficacy and safety of liraglutide once daily (LIRA) to exenatide twice daily (EXEN) in adult patients with type 2 diabetes, few studies have explored the associated per-patient costs of glycemic goal achievement of their use in a real-world clinical setting.MethodsThis retrospective cohort study used integrated medical and pharmacy claims linked with glycated hemoglobin A1C (A1C) results from the IMS Patient-Centric Integrated Data Warehouse. Patients’ ≥18 years and naïve to incretin therapies during a 6-month pre-index period, with ≥1 prescription for LIRA or EXEN between January 2010 and December 2010, were included. Patients with evidence of insulin use (pre- or post-index) were excluded. Only patients who were persistent on their index treatment during a 180-day post-index period were included. Follow-up A1C assessments were based on available laboratory data within 45 days before or after the 6-month post-index point in time. Diabetes-related pharmacy costs over the 6-month post-index period were captured and included costs for both the index drugs and concomitant diabetes medications.Results234 LIRA and 182 EXEN patients were identified for the analysis. The adjusted predicted diabetes-related pharmacy costs per patient over the 6-month post-index period were higher for LIRA compared to EXEN ($2,002 [95% confidence interval (CI): $1,981, $2,023] vs. $1,799 [95% CI: $1,778, $1,820]; P < 0.001). However, a higher adjusted predicted percentage of patients on LIRA reached A1C < 7% goal (64.4% [95% CI: 63.5, 65.3] vs. 53.6% [95% CI: 52.6, 54.6]; P < 0.05), translating into lower average diabetes-related pharmacy costs per successfully treated patient for LIRA as compared to EXEN ($3,108 vs. $3,354; P < 0.0001).ConclusionsAlthough predicted diabetes-related pharmacy costs were greater with LIRA vs. EXEN, a higher proportion of patients on LIRA achieved A1C < 7%, resulting in a lower per-patient cost of A1C goal achievement with LIRA compared to EXEN.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0098-8) contains supplementary material, which is available to authorized users.

Cost of Self-Monitoring of Blood Glucose in Canada among Patients on an Insulin Regimen for Diabetes.

IntroductionPeople with diabetes are at a higher risk of developing a variety of medical conditions relative to those without diabetes, resulting in increased healthcare costs. Self-monitoring of blood glucose (SMBG) is accepted as a recommended element of effective diabetes self-management. However, little is known about the real-world frequency and actual expenditures associated with SMBG, as well as the impact of SMBG costs relative to the cost of diabetes treatments. The primary objective is to evaluate the real-world utilization and costs of SMBG tests in Canada among insulin-treated diabetes patients during a 12-month follow-up period.MethodsA retrospective cohort study was conducted using the IMS Brogan Inc. Drug Plan database from July 1, 2006 through June 30, 2010. Total costs during the 12-month follow-up period were assessed, focusing on blood glucose (BG) testing strip costs, insulin therapy costs, and costs associated with oral antidiabetics medications. All prevalent patients with two or more prescriptions for insulin between January 1, 2007 and December 31, 2009 were initially included in the analysis, the first prescription serving as their index date. Depending on the insulin type(s) used, patients were subcategorized into one of four insulin regimen groups (basal, bolus, premix, or basal–bolus).ResultsAmong an initial sample of patients with two or more claims for insulin between January 1, 2007 and December 31, 2009, 142,551 met the aforementioned inclusion and exclusion criteria. An overall mean utilization of pharmacy-based blood glucose testing of approximately 1,094 strips per person per year was observed, with an average cost per testing strip of Canadian $0.79. SMBG treatment costs for insulin users ($860), specifically those associated with prescription testing strips, totaled 41.6% of the average annual pharmacy costs of diabetes-related prescriptions ($2,068).ConclusionThis study shows that SMBG accounts for approximately 40% of the total diabetes-related pharmacy costs for insulin users.

Comparison of utilization, cost, adherence, and hypoglycemia in patients with type 2 diabetes initiating rapid-acting insulin analog with prefilled pen versus vial/syringe

Background:Studies examining outcomes of different insulin delivery systems are limited. The objective of this study was to compare healthcare utilization, costs, adherence, and hypoglycemia rates in patients with type 2 diabetes mellitus (T2DM) initiating rapid-acting insulin analog (RAIA) using prefilled pen versus vial/syringe.Methods:A retrospective analysis was conducted using a US claims database (1/1/2007 to 12/31/2008). Inclusion criteria were: ≥18 years old, with T2DM, ≥12 months of continuous eligibility, and new to RAIA. Difference-in-difference analyses after propensity score matching were conducted to compare changes in outcomes from 6 months prior to and 6 months after initiating RAIA with a prefilled pen versus vial/syringe (Wilcoxon rank-sum test for costs and t-test for other outcomes). Categories of utilization and costs (2009 USD) included total and diabetes-related inpatient, outpatient, and emergency room. Adherence was measured by proportion of days covered (PDC). Hypoglycemia was identified using ICD-9-CM codes.Results:Baseline characteristics were similar between the prefilled pen (n = 239) and vial/syringe (n = 590) cohorts after matching. Adherence to RAIA was greater in the prefilled pen cohort than the vial/syringe cohort (PDC: 54.6 vs. 45.2%, p < 0.001). While the increase in diabetes-related pharmacy costs from before to after initiating RAIA was greater in the prefilled pen cohort than the vial/syringe cohort (+$900 vs. +$607, p < 0.001), the prefilled pen cohort was associated with greater reductions in the total diabetes-related costs (–$235 vs. +$61, p = 0.006) and the utilization of oral anti-hyperglycemic agents (–1.3 vs. –0.7, p = 0.016). There were no significant differences in other outcomes.Limitations:Claims databases do not provide optimal measures for adherence or T2DM severity, and only capture hypoglycemia events requiring clinical intervention.Conclusion:Initiating RAIA with a prefilled pen was associated with better adherence and greater reduction in total diabetes-related costs than a vial/syringe. There was no significant difference in total healthcare costs.