Medication usage, treatment intensification, and medical cost in patients with type 2 diabetes: a retrospective database study

Bonafede, Machaon; Chandran, Arthi; DiMario, Stefan; Saltiel-Berzin, Rita; Saliu, Drilon

doi:10.1136/bmjdrc-2015-000189

Cited by 16 publications

(9 citation statements)

References 37 publications

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“…Results from the current study are in line with those from another real-world retrospective analysis of T2D patients from the MarketScan database, which reported low rates of treatment intensification among patients with elevated HbA1c levels at baseline or during a 4-year follow-up period (8.0–9.2%). The percentage of patients with HbA1c > 7.0% at 4 years after initiation with a new class of anti-hyperglycemic medication ranged from 48% among patients initiating OADs to 74% of patients initiating basal insulin [ 20 ]. A retrospective study involving databases from the US and multiple European countries found that after 2 years of basal-insulin therapy, only 27.8% of patients achieved the HbA1c goal of < 7.0%, down from a mean baseline HbA1c level of 9.0% [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment Intensification in Type 2 Diabetes: A Real-World Study of 2-OAD Regimens, GLP-1 RAs, or Basal Insulin

et al. 2018

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IntroductionTreatment guidelines recommend a stepwise approach to glycemia management in patients with type 2 diabetes (T2D), but this may result in uncontrolled glycated hemoglobin A1c (HbA1c) between steps. This retrospective analysis compared clinical and economic outcomes among patients with uncontrolled T2D initiating two oral antidiabetes drugs (OADs), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), or basal insulin in a real-world setting.MethodsAdults with T2D on OAD monotherapy were identified in the MarketScan claims database (2007–2014). Those initiating two OADs (simultaneously or sequentially), GLP-1 RAs, or basal insulin were selected (date of initiation was termed the ‘index date’); patients were required to have HbA1c > 7.0% in the 6 months pre-index date. HbA1c was compared from 6 months pre- to 1-year post-index. Annual all-cause healthcare utilization and costs were reported over the 1-year follow-up period.ResultsData for 6054 patients were analyzed (2-OAD, n = 4442; GLP-1 RA, n = 361; basal insulin, n = 1251). Baseline HbA1c was high in all cohorts, but highest in the basal-insulin cohort. Treatment initiation resulted in reductions in HbA1c in all cohorts, which was generally maintained throughout the follow-up period. Average HbA1c reductions from the 6 months pre- to 1 year post-index date were −1.2% for GLP-1 RA, −1.6% for OADs, and −1.8% for basal insulin. HbA1c < 7.0% at 1 year occurred in 32.6%, 47.5%, and 41.1% of patients, respectively. Annual healthcare costs (mean [SD]) were lowest for OAD (US$10,074 [$22,276]) followed by GLP-1 RA (US$14,052 [$23,829]) and basal insulin (US$18,813 [$37,332]).ConclusionDespite robust HbA1c lowering following treatment initiation, many patients did not achieve HbA1c < 7.0%. Basal insulin, generally prescribed for patients with high baseline HbA1c, was associated with a large reduction in HbA1c and with higher costs. Therapy intensification at an appropriate time could lead to clinical and economic benefits and should be investigated further.FundingSanofi U.S., Inc.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0429-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Treatment Intensification in Type 2 Diabetes: A Real-World Study of 2-OAD Regimens, GLP-1 RAs, or Basal Insulin

et al. 2018

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“…The results of this study indicate that there may be a significant gap in post‐TIA and minor stroke care, specifically regarding optimization of secondary prevention medications. Although very little previous work has focused on medication optimization for secondary stroke prevention, studies in hypertension, hyperlipidemia, and diabetes have demonstrated low rates of timely and appropriate treatment even in the face of evidence‐based guidelines that promote medication optimization . Often, patients with these chronic diseases are unaware of the risks of delaying treatment optimization and view medication initiation and medication dose increases negatively .…”

Section: Discussionmentioning

confidence: 99%

The quality of medication optimization among patients with transient ischemic attack or minor stroke

Myers

Bravata

Sico

et al. 2019

J Am Coll Clin Pharm

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Objective To assess the quality of medication optimization for transient ischemic attack (TIA) and minor stroke patients across the Veterans Health Administration (VHA), and to identify characteristics predicting medication optimization for hypertension, hyperlipidemia, and diabetes. The scope of this study focuses on these three medication‐related conditions and defines optimization as medication changes or additions made within a guideline‐defined timeframe. Methods We constructed a retrospective cohort including all patients discharged with a TIA or minor stroke (index event) in any VHA Emergency Department (ED) or inpatient setting during fiscal year 2011. Inpatient and outpatient medical/pharmacy data were collected from a variety of electronic health sources for 1 year prior to and up to 90 days after discharge. Medication optimization for hypertension, hyperlipidemia, and diabetes was defined using relevant VHA and American Heart Association/American Stroke Association guidelines. For each of the three medication‐based outcomes, multivariable logistic regression models examined demographic, past medical history, and other clinical variables to identify predictors of optimization. Results Among 8427 patients, 33.7% (n = 2837) were eligible for medication optimization for hypertension, 55.2% (n = 4655) for hyperlipidemia, and 7.2% (n = 606) for diabetes. Guideline‐concordant medication optimization occurred for 28% of eligible patients with hypertension, 28% of patients with hyperlipidemia, and 34% of patients with diabetes. Factors that were associated with medication optimization included younger age, inpatient stay (vs discharge from the ED), greater baseline disease severity (higher blood pressure, low‐density lipoprotein [LDL] cholesterol, or hemoglobin A1c [glycated hemoglobin]), and primary care follow‐up within 30 days after the index event. Conclusion One‐third or fewer eligible patients with TIA or minor stroke had their medications optimized in a timely manner in concordance with evidence‐based guidelines. Interventions to improve timely medication optimization are needed to reduce the risk of recurrent vascular events in this high‐risk population.

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“…These findings are similar to the results of a study of diabetes treatment cohorts in the same claims database. Bonafede et al [ 14 ] found that all cause medical expenditures for the first year after type 2 diabetes diagnosis ranged from $8591 to $20,350, based on severity cohort. Increased health care utilization across the three cohorts was explained by a mix of both inpatient and outpatient visits.…”

Section: Discussionmentioning

confidence: 99%

Health Care Burden in Patients With Adrenal Insufficiency

Gunnarsson

Ryan

Marelli³

et al. 2017

Journal of the Endocrine Society

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Objective:This study aimed to estimate the annual health care burden for patients with adrenal insufficiency [AI; primary (PAI), secondary to pituitary disorder (PIT), and congenital adrenal hyperplasia (CAH)] using real-world data.Methods:Using a US-based payer database comprising >108 million members, strict inclusion criteria with diagnostic codes and pharmacy records were used to identify 10,383 patients with AI. This included 1014 patients with PAI, 8818 with PIT, and 551 with CAH, followed for >12 months. Patients were matched 1:1 to controls, based on age (±5 years), sex, insurance, and region. Multivariable expenditure models were estimated for each AI cohort vs controls as well as subsets by glucocorticoid therapy (hydrocortisone, dexamethasone, prednisone, or multiple therapies). A separate multivariable model was estimated to assess the association between adherence and expenditures.Results:Total annual health care expenditure estimates were significantly higher (P < 0.0001) in all AI cohorts compared with matched controls (PAI $18,624 vs $4320, PIT $32,218 vs $6956, CAH $7677 vs $4203). Patients with AI have more frequent inpatient hospital stays with up to eight to 10 times more days in the hospital per year than their matched controls. In each AI cohort, patients on multiple steroid therapies had higher expenditures in comparison with patients using hydrocortisone therapy alone. In PAI and PIT cohorts taking hydrocortisone only, fewer expenditures were found in higher adherence subsets.Conclusion:Patients with AI demonstrate a substantial annual health care burden. Expenditures vary by underlying cause and treatment and are reduced in patients with higher adherence to glucocorticoid replacement.

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Medication usage, treatment intensification, and medical cost in patients with type 2 diabetes: a retrospective database study

Cited by 16 publications

References 37 publications

Treatment Intensification in Type 2 Diabetes: A Real-World Study of 2-OAD Regimens, GLP-1 RAs, or Basal Insulin

Treatment Intensification in Type 2 Diabetes: A Real-World Study of 2-OAD Regimens, GLP-1 RAs, or Basal Insulin

The quality of medication optimization among patients with transient ischemic attack or minor stroke

Health Care Burden in Patients With Adrenal Insufficiency

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