Exploring the Impact of Device Sourcing on Real-World Adherence and Cost Implications of Continuous Glucose Monitoring in Patients With Diabetes: Retrospective Claims Analysis (Preprint)

Abstract

BACKGROUND Insurance benefit design influences whether individuals with diabetes who require a continuous glucose monitor (CGM) to provide real-time feedback on their blood glucose levels can obtain the CGM device from either a pharmacy or a durable medical equipment (DME) supplier. The impact of the acquisition channel on device adherence and healthcare costs has not been systematically evaluated. OBJECTIVE Retrospective claims analysis compared the adherence rates for patients new to CGM therapy and the costs of care for individuals who obtained CGM devices from a pharmacy versus acquisition through a DME supplier. METHODS Utilizing the Mariner Commercial Claims Database, individuals aged >18 years with documented diabetes and an initial CGM claim during the first quarter of 2021 (2021Q1, index date) were identified. Patients had to maintain uninterrupted enrollment for a duration of 12 months but file no CGM claim during the six months preceding the index date. Propensity score matching was employed to establish comparable Pharmacy and DME cohorts. Outcomes included quarterly adherence, retention, and costs for the period from 2021Q1 to the first quarter of 2022 (2022Q1). Between-cohort differences in adherence rates and retention rates were analyzed using z-tests, and cost differences were analyzed using t-tests. RESULTS Results: Propensity score matching was employed to establish comparable Pharmacy and DME cohorts. A total of 3,716 patients were identified, with 1,858 in the Pharmacy Cohort and 1,858 in the DME Cohort. Although adherence declined over time in both cohorts, the DME Cohort exhibited significantly superior adherence compared to the Pharmacy Cohort at 6 months (Pharmacy 39%; DME 49%; P<0.05), 9 months (Pharmacy 36%; DME 45%; P<0.05), and 12 months (Pharmacy 33%; DME 41%; P<0.05). Mean annual total medical costs for adherent patients in the Pharmacy Cohort were 18% (or $1,336) higher compared to the DME Cohort (Pharmacy $8,716; DME $7,380; P<0.01). In non-adherent patients, the DME Cohort exhibited a significantly higher rate of therapy reinitiation during the period compared to the Pharmacy Cohort (Pharmacy 12.1%; DME 18%; P<0.05). CONCLUSIONS The results from this real-world claims analysis demonstrate that, in a matched set of individuals who received their CGM through a DME supplier or a pharmacy, those whose supplies were provided through the DME channel were more adherent to their device. For individuals who experienced a lapse in therapy, those whose supplies were provided through the DME channel were more likely to resume use after an interruption than those who received their supplies from a pharmacy. In the matched cohort analysis, those who received their CGM equipment through a DME supplier demonstrated a lower total cost of care.