Cost-Related Insulin Underuse Among Patients With Diabetes

Herkert, Darby; Vijayakumar, Pavithra; Luo, Jing; Schwartz, Jeremy I.; Rabin, Tracy L.; DeFilippo, Eunice M.M.; Lipska, Kasia J.

doi:10.1001/jamainternmed.2018.5008

Cited by 184 publications

(150 citation statements)

References 5 publications

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“…Results of these two studies suggest that while RCTs might show lower hypoglycaemia risk and improved pharmacokinetic/pharmacodynamic profiles of long‐acting insulins compared with intermediate‐acting insulins, such as NPH, these benefits may not translate to real‐life clinical practice. Furthermore, the higher cost of long‐acting BI analogues compared with human insulins may be an important factor to consider when selecting insulin therapies; for instance, one USA‐based survey conducted in an urban diabetes centre indicated that 25% of individuals with diabetes reported cost‐related underuse of insulin, and this was associated with significantly poorer glycaemic control …”

Section: Can Newer Bi Analogues Assist With Insulin Titration and Trementioning

confidence: 99%

The importance of the initial period of basal insulin titration in people with diabetes

Khunti

Giorgino

Berard

et al. 2020

Diabetes Obesity Metabolism

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Achieving target glycaemic control is essential in people with diabetes to minimize the risk of long-term complications, and many people with type 2 diabetes will ultimately require basal insulin (BI) therapy to achieve their individualized glycaemic targets. Usually, the first 12 weeks following initiation of BI therapy represents the period when the greatest dose increases and glycaemic reductions occur. Effective glycaemic control combined with minimizing the risk of hypoglycaemia is important to enable the achievement of glycaemic control in the longer term. However, substantial therapeutic inertia exists in clinical practice, both in initiation and up-titration of BI, owing to patient-, physician-and healthcare system-related barriers, including fear of hypoglycaemia and the perception of a burdensome regimen. The more prolonged duration of action, reduced glycaemic variability and lower risk of hypoglycaemia seen with second-generation versus first-generation BI analogues may help alleviate patients' and physicians' concerns and facilitate titration. In turn, optimal BI titration and subsequent metabolic benefits may help improve therapy adherence and self-management. This review details the clinical implications of prompt titration of BI to achieve early glycaemic control, and the importance of minimizing hypoglycaemia risk within the initial titration period. Facilitation of patients' self-management of BI is also addressed. K E Y W O R D Sbasal insulin, glycaemic control, hypoglycaemia, insulin analogues, insulin therapy

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Section: Can Newer Bi Analogues Assist With Insulin Titration and Trementioning

confidence: 99%

The importance of the initial period of basal insulin titration in people with diabetes

Khunti

Giorgino

Berard

et al. 2020

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…36 A study conducted at Yale University found that 25% of patients with diabetes ration insulin because of the high cost. 13,37 There are 30 million patients with diabetes in the United States, and approximately 25% (7.4 million Americans) need insulin. 14 For the 1.3 million patients with type 1 diabetes, insulin is as vital as air and water.…”

Section: Possible Solutions Solutions At the State And Federal Policymentioning

confidence: 99%

The High Cost of Insulin in the United States: An Urgent Call to Action

Rajkumar

2020

Mayo Clinic Proceedings

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“…20 Indeed, insulin costs remain a singular point of tremendous focus in the diabetes cost landscape: consider that insulin prices increased 320% over the past 13 years 21 and that 1 in 4 patients reporting skipping insulin use due to cost from a recent single-center survey. 22 The heightened sensitivity and focus on insulin costs (among other types of drug costs) have led pharmaceutical companies to introduce generic versions, price caps, and pricing disclosures in consumer advertising, with mixed results. At the end of the day, the decoupling of the consumption of drugs versus its payment through insurance (for those with such coverage) mitigates the impact of pricing transparency on consumption decisions, among other factors.…”

Section: Diabetes Marketmentioning

confidence: 99%

The “Economic Health” of U.S. Health Care and Role of Middlemen

Garg

2020

Diabetes Technology & Therapeutics

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This article goes through the major components of the health care return-on-investment equation, from spending to outcomes, and attempts to identify major causes for its underperformance compared with other types of enterprise. It also explores the role of ''middlemen'' in prescription drug pricing (broadly defined as any market participant other than the drug manufacturer and the provider/patient, including-but not limited to-insurance companies, pharmacy benefit managers [PBMs], and health plans) and teases out the mechanisms by which PBMs, in particular, contribute to overall health care costs and the types of risks and returns they endure. Like any economic system, the health care system is a net zero-sum construct, whereby costs and benefits are traded off or exchanged between components of the value chain involuntarily (e.g., by regulatory or legal mandate) or voluntarily (e.g., by economic incentive). Ultimately, the question for policymakers as it relates to health care reform is to determine what combination of such exchanges leads to the best overall outcomes. This question of optimization, however, is undoubtedly challenging and complex, and can bring to bear economic, social, political, and moral dimensions. In light of these considerations, the article concludes by touching upon some perspectives for the future and ideas for reform, including payer reform, delivery disintermediation by technology, and consumer-driven health care.

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Cost-Related Insulin Underuse Among Patients With Diabetes

Abstract: Role of the Funder/Sponsor: The Robert Wood Johnson Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Cited by 184 publications

References 5 publications

The importance of the initial period of basal insulin titration in people with diabetes

The importance of the initial period of basal insulin titration in people with diabetes

The High Cost of Insulin in the United States: An Urgent Call to Action

The “Economic Health” of U.S. Health Care and Role of Middlemen

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