Early Discontinuation and Related Treatment Costs After Initiation of Basal Insulin in Type 2 Diabetes Patients

Abstract

Aims:The aim was to compare early discontinuation and related treatment costs in type 2 diabetes in primary care after initiation of insulin glargine or human basal insulin (NPH). Methods: Overall, 2765 glargine and 1554 NPH patients from 1072 general practices were analyzed (Disease Analyser). Early discontinuation was defined as switching to a different basal insulin or another insulin treatment regimen within 90 days after first basal insulin prescription (index date, ID). Treatment costs were assessed 365 days prior and post ID in both groups. Propensity score matching and linear regression was used to adjust cost differences (post vs prior ID: discontinued vs continued patients) for age, sex, diabetes duration, antidiabetic comedication, diabetologist care, disease management program participation, costs before ID, and Charlson Comorbidity Index. Results: Within 3 months after ID, 13% of glargine patients switched to other insulin treatment regimens (NPH: 18%; P < .05). After propensity score matching, adjusted cost differences in 146 discontinued versus 1342 continued glargine patients were calculated (NPH: 146 vs 1342). Diabetes-related prescription costs were lower among persistent glargine patients compared to persistent NPH patients ; P = .0109). Mean cost difference for diabetes-related prescriptions was lower among those who persisted on glargine compared to those who switched to other treatment regimens , P = .0780). Conclusions: Treatment persistence within 3 months after basal insulin initiation was significantly higher under insulin glargine compared to NPH. Diabetes-related prescription costs were significantly lower among patients who adhered to insulin glargine compared to persistent NPH patients.

Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review

“…This result was mainly driven by a significant increase in pharmacy costs in persistent versus nonpersistent patients (US$5,571 vs US$2,931; P <0.001) that was not offset by a reduction in medical costs (ambulatory and ER visits, inpatient, and other costs) (US$3,103 vs US$4,516; P =0.047) 20. Anderten et al found that, while the annual cost difference for DM-related prescriptions was lower in German patients with T2DM who persistently used insulin glargine compared with patients who switched insulin type, this failed to reach statistical significance 13. Similarly, total treatment costs (DM-related prescriptions and other medical services) were lower but not significantly different between persistent and nonpersistent insulin glargine patients.…”

“…Pharmacy/drug/medication costs were specifically reported as being included in the analyses of all studies, 13 reported including inpatient, hospitalization, and/or emergency room (ER) costs, and outpatient or ambulatory costs were reported in 10 studies. Some studies were, however, vague about what expenses were actually considered, instead just referring to “medical” or “total” costs in their methodologies 11,13–17. Only two studies considered the costs of nonadherence outside the health care system: patient co-payments were included in one study and out-of-pocket expenses were included in another 18,19.…”

Costs and Its Drivers for Diabetes Mellitus Type 2 Patients in France and Germany: A Systematic Review of Economic Studies

“…Three focused on the period around insulin initiation. Costs for type 2 diabetes treatment in the year prior insulin initiation ranged between €757.00 and €843.07 and rose to €1277.85 up to €2204.41 after insulin initiation (48,52). Costs for the year around insulin initiation (6 months prior and 6 months after initiation) amount between €1828.43 and €1844.00, respectively (48,51).…”

“…Higher direct healthcare costs were reported for patients with longer disease duration (56). For France as well as for Germany, patients treated with insulin caused higher costs than patients treated without insulin (43,48,51,52,56,62,64).…”

Insulintherapie bei Diabetes mellitus Typ 2: patientenzentriert, rechtzeitig, nutzen-risiko-bilanziert; Standortbestimmung 2019 nach dem ADA/EASD-Konsensus 2018

“…2). Eine Therapiekostenanalyse aus Deutschland ergab, dass der durchschnittliche Kostenunterschied zwischen diabetesbedingten Verschreibungen für diejenigen, die weiterhin Glargin einnahmen, geringer war als für diejenigen, die auf andere Behandlungsmethoden umstellten [64].…”