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Total insulin costs can be reduced through higher utilization of pen devices by patients in long-term care facilities.

To evaluate medical and pharmacy costs associated with breakthrough pain (BTP) in a commercially-insured population with chronic, cancer-related pain. METHODS: The National Breakthrough Pain Survey studied a large commercially-insured population using claims data and structured interviews to assess the prevalence, characteristics, and impact of BTP. Adult patients with ≥2 medical claims at an interval ≥3 months with an ICD-9-CM code indicating a chronic pain condition (cancer or noncancer) and ≥3 opioid prescription claims consistent with chronic use were eligible. Patients were called and interviewed after providing consent; those verifying cancer pain were included in this sub-analysis. All-cause medical and pharmacy costs in 2010 US dollars were determined from administrative claims data for the 12-month period before the survey date. Generalized linear models with gamma distribution were constructed because of the skewed nature of the cost data. RESULTS: A total of 2198 patients were interviewed, 1279 had controlled persistent pain, and 145 of the latter group had cancer pain. Of those with cancer pain, BTP was reported by 77.2% (BTP, 112; no BTP, 33

OBJECTIVES:The National Healthcare Group Polyclinics (NHGP) is a group of 9 public sector primary care clinics in Singapore. This study examines the factors associated with poor glycaemic control in Asian patients with type 2 diabetes mellitus (T2DM) in Singapore. METHODS: This is a cross-sectional study of patients with T2DM who attended the same clinic in 2009 for the treatment of diabetes. Demographic characteristics, medical diagnosis, clinical parameters and laboratory results were extracted from the group's Diabetes Registry (CDMS). Glycaemic (HbA1c) and cholesterol (LDL-c) control were compared with age and logistic regression analysis was applied to study the factors associated with poor glycaemic control using HbA1c cut-off at 8%. RESULTS: Among the 58,057 T2DM patients were more females (54%), disproportionately more Indians (13%) and fewer Chinese (71%) than the general population. Both HbA1c and LDL-c improved with age. The mean HbA1c decreased gradually from 8.16Ϯ1.74% (Ͻ40 years) to 6.94Ϯ0.99% (80ϩ years) while mean LDL-c dropped from 2.84Ϯ0.80 to 2.56Ϯ0.70. The Indian and Malay groups had significantly poorer glycaemic control compared to the Chinese, AdjOR 1.66 (95%CI:1.56-1.77) and 1.53 (95%CI:1.43-1.63) respectively. Other significant predictors of poor glycaemic control included the male gender (AdjOR 1.19; 95%CI 1.19:1.14-1.25), presence of maculopathy or retinopathy, peripheral vascular disease, coronary heart disease, heart failure, and being on insulin therapy (AdjOR 8.00; 95%CI:7.54-8.48). Patients with poor LDL-c (4.0ϩ mmol/L) were 4.2 times the odds of having poor glycaemic control (95%CI:3.78-4.66) while those with Grade 2 hypertension were 1.5 times (95%CI:1.35-1.76). CONCLUSIONS: Younger T2DM patients had poorer glycaemic and cholesterol control than older patients. Those with poor glycaemic control also had corresponding poorer cholesterol and blood pressure control. These patients had a higher lifetime risk of developing micro-and macro-vascular complications and should be treated much more aggressively to achieve "optimal" glycaemic and cholesterol control.

The final CMS rule on short-fills is unlikely to result in savings to Medicare Part D plans. Shorter fill times and inclusion of generic products would significantly raise costs to these plans.