Mining treatment patterns of glucose-lowering medications for type 2 diabetes in the Netherlands

Heuvel, Jan Maurik van den; Farzan, Niloufar; Hoek, Mandy van; Zee, Anke‐Hilse Maitland‐van der; Ahmadizar, Fariba

doi:10.1136/bmjdrc-2019-000767

Cited by 12 publications

(8 citation statements)

References 23 publications

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“…We determined the main treatment pathways based on the most frequent two-step combinations, which are changes from one treatment to another among at least 1% of pregnancies with antiemetic medication fills. 33 Treatment steps were considered the start (date of dispensing) and the end date (calculated from the number of DDDs dispensed) of prescription fills, taking into account the allowed gap of 14 days to correct for medication possession gaps due to non-adherence.…”

Section: Methodsmentioning

confidence: 99%

Antiemetic Prescription Fills in Pregnancy: A Drug Utilization Study Among 762,437 Pregnancies in Norway

Gelder¹,

Nordeng²

2021

CLEP

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Objective To determine antiemetic prescription fill patterns during pregnancy in Norway, with special focus on the use of ondansetron and recurrent use in subsequent pregnancies. Methods We conducted a population-based registry study based on data from the Medical Birth Registry of Norway linked to the Norwegian Prescription Database for 762,437 pregnancies >12 gestational weeks ending in live or non-live births between 2005 and 2017. Prescription fills of medications used for nausea and vomiting of pregnancy were summarized in treatment pathways to determine drug utilization patterns. Logistic regression analyses were used to estimate associations between maternal and pregnancy characteristics and antiemetic prescription fills. Results The prescription fill rate for antiemetic medication during pregnancy was 7.6%. However, prescription fill rates were 35.5% in the second pregnancy after filling an antiemetic prescription in the first pregnancy and 53.5% for women who filled antiemetic prescriptions in the previous 2 pregnancies. Among pregnancies with antiemetic prescription fills, 62.2% were dispensed metoclopramide, 28.2% meclizine, and 17.2% promethazine. First-line treatment started with monotherapy in 97.4% of these pregnancies, which was the only treatment received in 78.7%. Prescriptions for ondansetron were filled in 0.3% of pregnancies, with 76.9% being initially filled in the first trimester. Ondansetron as first-line prescription medication and/or use in the first trimester was associated with proxies for more severe nausea and vomiting of pregnancy, including a diagnosis of hyperemesis gravidarum, multiple gestations, a higher obstetric comorbidity index, and concomitant use of medication for gastroesophageal reflux disease and nervous system medications. Women who filled an antiemetic prescription in their first pregnancy were less likely to have subsequent pregnancies than women who did not fill an antiemetic prescription in their first pregnancy (OR 0.93, 95% CI 0.90–0.96). Conclusion Complex patterns of antiemetic prescription fills in pregnancy may mirror the challenge of optimal management of nausea and vomiting of pregnancy in clinical practice, especially for women with severe symptoms.

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Section: Methodsmentioning

confidence: 99%

Antiemetic Prescription Fills in Pregnancy: A Drug Utilization Study Among 762,437 Pregnancies in Norway

Gelder¹,

Nordeng²

2021

CLEP

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“…A 5‐year longitudinal study showed 84% of people with type 2 diabetes start biguanides (metformin). The next most common treatment (in 19% of cases) is biguanides + sulfonylurea 12 . Despite reimbursement of dapagliflozin when added to metformin plus sulfonylurea, use of dapagliflozin in the Netherlands is limited, partially due to cost considerations 13 .…”

Section: Introductionmentioning

confidence: 99%

The cost‐effectiveness of dapagliflozin compared to DPP‐4 inhibitors in the treatment of type 2 diabetes mellitus in the Netherlands

et al. 2020

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Aim When glycaemic control for people with type 2 diabetes is not achieved with metformin and sulfonylurea alone, adding another oral anti‐diabetes drug, such as a sodium–glucose co‐transporter 2 (SGLT2) or dipeptidyl peptidase‐4 (DPP‐4) inhibitor, is an alternative to starting insulin. The aim of this study is to determine the cost‐effectiveness of dapagliflozin (an SGLT2 inhibitor) compared with DPP‐4 inhibitors when added to metformin and sulfonylurea in people with type 2 diabetes in the Netherlands. Methods A cost–utility analysis is performed using the Cardiff diabetes model, a fixed‐time increment stochastic simulation model informed by ‘United Kingdom Prospective Diabetes Study 68’ risk equations. The base‐case analysis uses a 40‐year time horizon, a Dutch societal perspective and differential discounting (4% for costs, 1.5% for effects). Inputs are obtained from the literature and Dutch price lists. Univariate and probabilistic sensitivity analysis are performed. Results Dapagliflozin is dominant compared with DPP‐4 inhibitors, resulting in a €990 cost saving and a 0.28 quality‐adjusted life year gain over 40 years. Cost savings are associated mainly with treatment costs and a reduced incidence of micro‐ and macrovascular complications, among others nephropathy, myocardial infarction and stroke. Results are robust to changes in input parameters. Conclusions Dapagliflozin is a cost‐saving alternative to DPP‐4 inhibitors when added to metformin and sulfonylurea. The incidence of micro‐ and macrovascular complications is lower for people treated with dapagliflozin. Uncertainty around this outcome is low.

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Section: Methodsmentioning

confidence: 99%

“…NControl adheres to data protection and privacy regulations, as established in among others the Personal Data Protection Act in The Netherlands as well as The Netherlands Norm (NEN) 7510 standard on information protection in healthcare, which is derived from International Organisation for Standardization (ISO) norm 27001 and 27002. 15 Subject and drug selection Selection of subjects was performed using the NControl database between 1 January 2013 and 1 January 2019. Chronic patients were defined based on the frequency by and the duration for which patients received dispensions of chronic disease-specific medications.…”

Section: Databasementioning

confidence: 99%

Higher prescription of antidepressants and/or anxiolytics among chronic obstructive pulmonary disease patients

Pelgrim

Heuvel

Folkerts

et al. 2021

Ther Adv Respir Dis

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Background: Chronic obstructive pulmonary disease (COPD) is often accompanied by psychiatric problems, such as depression and anxiety, affecting both treatment outcomes and mortality. Evidence for the number of COPD patients using medication for these disorders is sparse. In this study, chronic antidepressant (ATD) and anxiolytic (ANX) drug use – to identify depression and anxiety – among COPD patients was compared with subjects with or without other chronic diseases. Methods: The NControl database containing prescription data of 800 pharmacies including 7 million individuals in The Netherlands was used. Patients of age 55+ years who received frequent prescriptions – at least two/year in 5 out of 6 years – for COPD medication, dermatological drugs, disease-modifying antirheumatic drugs (DMARDs), statins and oral glucose-lowering medication were analyzed for concomitant chronic use of ATDs and ANXs between 1 January 2013 and 1 January 2019. All other subjects aged 55+ years were included as a control group (control group 1). This group was further stratified into a group of subjects that received frequent prescriptions of any kind (control group 2). Results: 15.2% of the patients that receive COPD treatment ( n = 96,319), 15.3% of subjects that are treated for dermatological problems ( n = 62,865), 13.2% of subjects that receive DMARDs ( n = 7900), 11.6% of statins users ( n = 422,376) and 11.4% of oral glucose-lowering medication users ( n = 165,975) are also chronically treated for depression or anxiety, compared with 2.6% (control group 1; n = 3,290,608) and 11.4% (control group 2; n = 757,947). In general, female and 75+ years aged subjects showed a higher risk for using ATDs and ANXs chronically. In the COPD and the dermatological patient group the risk was the highest compared with the other patient groups. Conclusions: The rates of chronic ATD and ANX use and the risk of having depression and/or anxiety are especially high in COPD patients, indicating that psychiatric problems are more common in COPD than in most other chronic diseases. In general, age and gender strongly influence the risk of chronically using ATDs and ANXs. The reviews of this paper are available via the supplemental material section.

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Mining treatment patterns of glucose-lowering medications for type 2 diabetes in the Netherlands

Cited by 12 publications

References 23 publications

Antiemetic Prescription Fills in Pregnancy: A Drug Utilization Study Among 762,437 Pregnancies in Norway

Antiemetic Prescription Fills in Pregnancy: A Drug Utilization Study Among 762,437 Pregnancies in Norway

The cost‐effectiveness of dapagliflozin compared to DPP‐4 inhibitors in the treatment of type 2 diabetes mellitus in the Netherlands

Higher prescription of antidepressants and/or anxiolytics among chronic obstructive pulmonary disease patients

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