Publications by authors named "Mark Aagren"

31 Publications

Preference for Immunotherapy with Tablets by People with Allergic Rhinitis.

Patient Prefer Adherence 2021 18;15:2539-2549. Epub 2021 Nov 18.

Incentive Denmark, Holte, Denmark.

Background: People with allergic rhinitis (AR) who are not controlled on conventional therapy can be treated using allergy immunotherapy (AIT) administered as tablets, injections or drops. In the US, the use of sublingual immunotherapy as tablets (SLIT-tablets) is limited in comparison to subcutaneous immunotherapy (SCIT).

Objective: This study investigated patients' preference for SLIT-tablets vs monthly or weekly SCIT from a US patient perspective.

Methods: We carried out a discrete choice experiment (DCE) consisting of two blocks with eight choice sets. Adults and caregivers of children with moderate-to-severe AR were included if they had not previously or were not currently receiving AIT. Three attributes were included in the design: the mode and frequency of administration, the risk of systemic reactions and the co-payment.

Results: A total of 724 adults with AR and 665 caregivers of children with AR were included in the study. Both adults and caregivers had a significant preference for SLIT-tablets compared with both weekly and monthly injections and for less risk of anaphylactic shock. Caregivers were more risk-averse than adults when choosing their treatment, and the younger the child, the more risk-averse the caregiver. The preference for SLIT-tablets was found for both monoallergic and polyallergic adults and caregivers of monoallergic and polyallergic children. Respondents not wanting AIT for free were more risk-averse than those indicating that they wanted AIT for free.

Conclusion: Our findings suggest that SLIT-tablets is the preferred route of administration for AIT among adults and caregivers of children with AR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/PPA.S338337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8608245PMC
November 2021

Subcutaneous immunotherapy takes more than the time in the clinic.

Curr Med Res Opin 2021 11 22;37(11):1925-1931. Epub 2021 Sep 22.

Incentive Denmark, Holte, Denmark.

Objective: The aim of this study was to investigate the time use and both direct and indirect costs associated with subcutaneous immunotherapy (SCIT) for adults with allergic rhinitis (AR) and caregivers of children with AR in the US.

Methods: We conducted a survey to assess the retrospective time use and direct costs of SCIT. The populations surveyed included adults and caregivers of children (aged 5-17) with symptomatic AR of moderate or higher severity who are currently receiving or have previously started allergy immunotherapy (AIT). The retrospectively collected, self-reported time consumption and direct costs per clinic visit when receiving SCIT were assessed as well as the productivity loss associated with SCIT. Data were analyzed using univariate descriptive statistics.

Results: The study included 106 adults with AR and 191 caregivers of children with AR. We found that the median time spent per visit to the clinic was 50 min for both groups, including travel time and time at the clinic. The direct costs related to each visit included parking fees, road tolls and other costs. Adults spent $10 on parking, $9 on tolls and $10 on other costs. Finally, a median of 4 h of work was missed for both the adult patients and the adults accompanying a child.

Conclusions: We found that SCIT is associated with substantial direct patient costs and productivity loss for both adults with AR and caregivers of children with AR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/03007995.2021.1976126DOI Listing
November 2021

Real-world evidence costs of allergic rhinitis and allergy immunotherapy in the commercially insured United States population.

Curr Med Res Opin 2021 06 2;37(6):957-965. Epub 2021 Apr 2.

ALK-Abelló, Hørsholm, Denmark.

Objective: To assess total and allergic rhinitis (AR)-related healthcare costs among AR patients residing in the United States with a focus on patients persisting with AIT.

Methods: AR patients were identified in the IBM MarketScan database between 1 January 2014 to 31 March 2017. Patients receiving allergy immunotherapy (AIT) were identified with relevant billing codes (earliest AIT claim = index date); non-AIT patients were identified with claims containing a diagnosis code for AR (earliest AR claim = index date). AIT patients reaching 25+ injection claims were analyzed as a separate maintenance cohort. All patients were required to have continuous enrollment for 12 months preceding and following index.

Results: A total of 2,334,530 AR patients were included; 103,207 had at least 1 AIT claim, with 45,279 (43.9%) of these patients reaching maintenance, and 24,640 AIT patients (23.9%) never presenting a single injection claim. Compared to non-AIT patients, patients initiating AIT presented higher rates of baseline comorbidities, including asthma (30.1% vs. 7.5%) and conjunctivitis (21.7% vs. 4.4%). During the follow-up period, patients reaching the maintenance phase of AIT incurred lower total costs than the overall AIT cohort ($10,431±$16,606 vs. $11,612±$24,797), and also presented lower follow-up hospitalization costs ($698±$7,248 vs. $1,281±$12,991) and total medical costs ($7950±$13,844 vs. $8989±$22,019).

Conclusions: Continued efforts are needed to increase patient awareness of available options and adherence to AIT, along with reducing wastage. Despite AIT patients presenting fairly progressed disease at the time of treatment initiation, this therapy remains an economical treatment option, as it was not accompanied by substantial increases in overall healthcare expenditure, and may promote positive societal impacts beyond the direct medical costs.What is known on this topicThe prevalence of allergic diseases has increased over the past 50 years and affects between 10-30% of the world population.Allergic rhinitis (AR) poses a significant economic burden in the form of both direct and indirect costsAllergy immunotherapy (AIT) is the only treatment option able to modify the underlying course of the disease.What this study addsSpecific all-cause and AR-related healthcare costs decreased following the initiation of AIT among patients diagnosed with AR, with the largest decreases observed among AIT patients reaching the maintenance phase of treatment, while non-AIT patients showed increases in all categories assessed over a similar follow-up period.Cost decreases among AIT patients were observed despite increased levels of comorbidities compared to non-AIT patients, as the AIT cohort presented elevated rates of atopic dermatitis (7.1% vs. 2.7%), conjunctivitis (21.7% vs. 4.4%), asthma (30.1% vs. 7.5%), and chronic sinusitis (22.6% vs. 4.9%).An analysis of patients' index subcutaneous AIT consultation revealed substantial variability in the initial treatment costs, with nearly 20% of paid amounts exceeding $1,000; given nearly 1 in 4 AIT patients who get AIT mixed never came back for their first injection, this highlights an opportunity to target frontloaded billing practices and the timing of mixing/injection as an area to minimize healthcare waste.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/03007995.2021.1903848DOI Listing
June 2021

Real-world mapping of allergy immunotherapy in the United States: The argument for improving adherence.

Allergy Asthma Proc 2021 01 23;42(1):55-64. Epub 2020 Dec 23.

IBM Watson Health, Cambridge, Massachusetts.

There is a dearth of real-world evidence studies focused on allergy immunotherapy (AIT) use among patients with allergic rhinitis (AR). This study examined claims data of AR patients residing in the United States to assess patient characteristics and health outcomes. AR patients were identified in the IBM MarketScan database between January 1, 2014, and March 31, 2017. Patients receiving AIT were identified with relevant billing codes (earliest AIT claim for vaccine as the index date); patients without AIT were identified with claims that contained a diagnosis code for AR (earliest AR claim as the index date). All the patients were required to have continuous enrollment 12 months prior to and following their index date. AIT patients reaching 25+ injection claims were analyzed as a separate maintenance cohort. Patients were assessed for demographic characteristics, comorbid conditions, and health care utilization. A total of 2,334,530 AR patients were included; 103,207 had at least one AIT claim, with 45,279 (43.9%) of these patients reaching maintenance. Patients who reached AIT maintenance presented higher rates of baseline comorbidities than both the full AIT cohort and the patients with no AIT claims, including asthma (34.6% versus 30.1% versus 7.5%) and upper respiratory tract infections (63.1% versus 60.3% versus 34.2%). From baseline to follow-up, maintenance AIT patients demonstrated reductions in all AR-related comorbidities assessed, along with reductions in all-cause and AR-related service utilization. Patients initiating AIT presented the greatest need for therapeutic intervention, as evidenced by higher allergy-related comorbidities; those who reached maintenance demonstrated improved outcomes following the initiation of therapy. Continued efforts to increase patient awareness and adherence to AIT are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2500/aap.2021.42.200114DOI Listing
January 2021

Evidence supporting an association between hypoglycemic events and depression.

Curr Med Res Opin 2013 Dec 23;29(12):1609-15. Epub 2013 Sep 23.

Novo Nordisk , Princeton, NJ , USA.

Objectives: This retrospective study investigated the association between hypoglycemic events (HEs) and depression events (DEs) in patients with diabetes mellitus (type 1 and type 2).

Methods: Analyzed data were from health care claims for individuals with employer-sponsored primary or Medicare supplemental insurance from the Thomson Reuters Market Scan database during the years 2008 and 2009. A baseline period (January 2008 to December 2008) was used to identify eligible patients and collect baseline clinical and demographic characteristics. Eligible patients were aged ≥18 years with diabetes (ICD-9-CM codes: 250.00, 250.01, 250.02, 250.03) who had not experienced any HEs or DEs and were not on antidepressant therapy during the baseline period. We studied the relationships between the DEs and HEs before and after adjusting for the covariates.

Results: Of the 923,024 patients meeting the inclusion criteria, 22,735 (2.46%) patients had HEs (ICD-9-CM coded: 251.0, 251.1, 251.2, 250.8) and 6164 (0.67%) patients had DEs (ICD-9-CM: 311) during the evaluation period. Patients reporting HEs had 78% higher odds of experiencing depression than patients without HEs before adjusting for the covariates. Similarly, after adjusting for the covariates, data indicated that patients with HEs had higher odds of experiencing depression (OR = 1.726; 95% CI = 1.52-1.96). Similar analyses in different age categories showed that the OR monotonically increases with age regardless of whether the other covariates are included in the model.

Conclusions: ICD-9-CM-coded HEs were independently associated with an increased risk of DEs in patients with diabetes, and this incidence increased with the patients' age.

Key Limitations: A key limitation to this study is that only those HEs that resulted in health care provider contact and subsequent claims coding indicative of hypoglycemia were included. It is likely that many cases of mild hypoglycemia, particularly those not severe enough to warrant medical attention, were not captured in this study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1185/03007995.2013.830599DOI Listing
December 2013

Differences in rates of hypoglycemia and health care costs in patients treated with insulin aspart in pens versus vials.

Curr Med Res Opin 2013 Oct 7;29(10):1287-96. Epub 2013 Aug 7.

University of Illinois, College of Medicine , Peoria, IL , USA.

Objectives: To study whether initiation of insulin aspart therapy with a pen vs. a vial/syringe has an impact on the risk of subsequent hypoglycemic episodes and health care costs.

Methods: This was a longitudinal, retrospective analysis of the MarketScan and IMS LifeLink health plan claims databases for patients with type 1 or type 2 diabetes who initiated insulin aspart with a pen or a vial/syringe. Included were adults (≥18 years) who had received no short-acting insulin for the 6 months prior to their index date (date of first claim for either treatment) and who initiated treatment with insulin aspart with a pen or with a conventional vial/syringe during the period from January 1, 2004, through December 31, 2007, based on outpatient pharmacy claims data. Patients were excluded if they did not have at least two claims for the index treatment during the 12 month post-index period. Hypoglycemic episodes were identified by any claim containing a diagnosis code for hypoglycemia.

Results: Analyses include 6065 patients in the pen group and 5523 patients in the vial/syringe group in the MarketScan database and 4512 patients in the pen group and 3782 patients in the vial/syringe group in the LifeLink database. Vial/syringe use was associated with 35% greater odds of at least one hypoglycemic episode than pen use in the MarketScan database (P < 0.001) and 44% greater odds in the LifeLink database (P < 0.001). Use of vials/syringes was associated with 89% and 62.7% greater health care costs for hypoglycemic events than use of pens, respectively (P < 0.001 for both databases). Patient groups were subject to selection bias as they did not have random assignment to treatment groups.

Conclusions: In two independent claims databases, initiation of insulin aspart treatment with pen was associated with fewer hypoglycemic events and lower diabetes-related health care costs than initiation with vial/syringe.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1185/03007995.2013.825590DOI Listing
October 2013

Assessing achievement and maintenance of glycemic control by patients initiating basal insulin.

Curr Med Res Opin 2012 Oct 2;28(10):1647-56. Epub 2012 Sep 2.

United BioSource Corporation, Lexington, MA, USA.

Objective: Describe characteristics of diabetic patients who initiated basal insulin and assess their glycemic control.

Research Design And Methods: Physician encounters in the General Electric EMR Database (2005-2010) were assessed for patients with type II diabetes (T2DM) who initiated basal insulin between February 2006 and August 2009, with initiation defined as no prescription record of insulin in prior 15 months. Patients were followed for an average 2.5 years after insulin initiation. The proportion and time to achieving HbA1c ≤ 7% ('goal') were assessed. Among patients who reached goal, the proportion and time to HbA1c increasing above 7% were analyzed. Cox proportional hazard models were estimated to identify predictors of HbA1c goal achievement and goal sustainability.

Results: Basal insulin initiators with T2DM (n = 13,373) were on average 60 years old, 50.5% were females, and 59.5% had HbA1c > 8%; 5840 (44%) patients reached goal within one year and 7699 (58%) reached goal during the ∼2.5-year follow-up. Being older, white or male, lower baseline HbA1c values, and no OAD use before insulin initiation were associated with significantly higher rates of reaching goal. Among patients who reached goal, 57.6% could not sustain the goal. Being Hispanic, higher baseline HbA1c values, and baseline OAD use were associated with significantly lower rates of goal sustainment.

Conclusion: A high proportion of T2DM patients did not have adequate glycemic control after initiating basal insulin. Various factors existing prior to insulin initiation were related to successful treatment of T2DM. Further research on how to improve glycemic control is encouraged.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1185/03007995.2012.722989DOI Listing
October 2012

Administration burden associated with recombinant human growth hormone treatment: perspectives of patients and caregivers.

J Pediatr Nurs 2013 Jan 30;28(1):55-63. Epub 2012 Jan 30.

MAGIC Foundation, Oak Park, IL, USA.

Patients treated with recombinant human growth hormone (rhGH) for growth hormone disorders follow a challenging treatment schedule. This study assessed patient and caregiver experiences with rhGH therapy treatment regimens. Patients 13 years or older with growth hormone deficiency and caregivers completed Web-based surveys. A total of 61 patients and 239 caregivers participated. Storage of rhGH was considered burdensome by more than a third. More than 51% considered storage "somewhat more" to "much more of a burden" relative to the burden while not traveling. "Away from home or traveling" was the most frequently endorsed reason for missing a dose. rhGH treatment while traveling is challenging because of rhGH storage burden.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pedn.2011.12.006DOI Listing
January 2013

Cost of self-monitoring of blood glucose in the United States among patients on an insulin regimen for diabetes.

J Manag Care Pharm 2012 Jan-Feb;18(1):21-32

Economics and Outcomes Research, IMS Consulting Group, 3 Lagoon Dr., Ste. 230, Redwood City, CA 94065, USA.

Background: People with diabetes are at an increased risk of developing numerous complications, resulting in increased health care expenditures, economic burden, and higher mortality. For patients using an insulin pump or multiple insulin injections, self-monitoring of blood glucose (SMBG) is recognized as a core component of effective diabetes self-management. However, little is known about the real-world frequency and true costs associated with SMBG as a percentage of an insulin regimen in the United States.

Objective: To evaluate SMBG frequency, SMBG-related costs (including blood glucose test strips and testing supplies), and insulin therapy costs among insulin-dependent patients with diabetes and at least 1 pharmacy claim for blood glucose testing strips during a 12-month follow-up period.

Methods: A retrospective database analysis was conducted using the IMS LifeLink Health Plan Claims database to capture the frequency and costs associated with SMBG in relation to a specific insulin regimen, and SMBG expenditure compared with other treatment costs. The study employed a retrospective cohort analysis of patients with 2 or more claims for insulin between January 1, 2007, and June 30, 2009, with the first such claim representing the index date. All patients were required to have 6 months of pre-index continuous enrollment (pre-index period) and 12 months of post-index continuous enrollment (follow-up period). Patients were also required to have a diagnosis of diabetes in the pre-index period and to have no gaps of more than 90 days between consecutive insulin claims during the 360-day follow-up period. Patients without at least 1 pharmacy claim for blood glucose testing strips during the 12-month follow-up period and patients with pharmacy claims with extreme values (greater than 1,500 strips) were excluded. Depending on the insulin types used within the 30 days immediately following their index date, patients were subcategorized into 1 of 4 insulin regimen groups (basal, bolus, premixed, or basal-bolus). Patients' frequency of blood glucose testing was measured throughout their 12-month post-index follow-up period through analysis of clinical codes found on pharmacy claims. Quantity supplied fields on pharmacy claims were used to calculate total tests utilized over the follow-up period (e.g., 50 test strips dispensed=50 tests assumed). Insulin-related costs were also evaluated for the 12-month follow-up period.

Results: Among an initial sample of 373,946 patients with at least 2 claims for insulin between January 1, 2007, and June 30, 2009, 45,555 patients (12.2%) formed the final overall cohort who met the inclusion and exclusion criteria. SMBG-related pharmacy costs accounted for 27% of the insulin-and SMBG-related treatment costs for insulin users with an average $772 per patient in prescription testing strips and supplies versus $2,078 for insulin prescriptions and supplies. With an overall mean utilization for pharmacy-based SMBG testing of 764.3 strips per year, the average cost per testing strip was $0.98. Annual SMBG costs were 24.5% of total insulin and SMBG-related pharmacy costs for the basal insulin group compared with 35.8% for bolus, 21.0% for premixed, and 26.4% for basal-bolus.

Conclusion: For insulin users with at least 1 pharmacy claim for glucose test strips, SMBG-related costs accounted for about one-fourth of total insulin and SMBG-related pharmacy costs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18553/jmcp.2012.18.1.21DOI Listing
August 2012

Cost-effectiveness of insulin detemir: a systematic review.

Expert Rev Pharmacoecon Outcomes Res 2011 Dec 3;11(6):641-55. Epub 2011 Oct 3.

Chung-Ang University College of Pharmacy, 221 Heukseok-dong, Dongjak-gu, Seoul, South Korea.

The prevalence of diabetes and cost of associated treatment are steadily increasing, as is the resulting burden on healthcare systems worldwide. Current treatment recommendations for Type 1 and Type 2 diabetes advise a prominent role for basal insulin. We examined the published health-economic literature pertaining to the basal insulin analog insulin detemir (IDet) to determine whether IDet is a cost-saving and/or cost-effective treatment for suboptimally controlled Type 1 or Type 2 diabetes. A total of 15 modeling studies were assessed, most of which found IDet to be cost effective compared with neutral protamine Hagedorn and as cost effective as insulin glargine. Those that did not find IDet to be cost effective set the disutility of hypoglycemic events to almost zero or assumed a higher dose of IDet with no difference in treatment effect, ignoring the clinical benefits and cost savings associated with IDet in studies demonstrating comparable or superior glycemic control with less hypoglycemia versus other basal insulins. The evidence suggests that IDet is cost effective versus neutral protamine Hagedorn and at least as cost effective as insulin glargine in the treatment of patients with suboptimally controlled Type 1 and Type 2 diabetes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1586/erp.11.73DOI Listing
December 2011

Coverage of insulin delivery devices and basal insulin analogs by US managed care organizations.

J Med Econ 2011 8;14(6):720-8. Epub 2011 Sep 8.

Clinical Development, Medical and Regulatory Affairs, Strategic Scientific Communications, Novo Nordisk Inc., Princeton, NJ 08540, USA.

Objective: The perception in the US is that insulin formulations prescribed for type 1 and type 2 diabetes and delivered via insulin pens are more costly to patients than the same or similar products provided in vials, and that basal insulin analogs offered either in pens or vials are likewise more costly to patients than human insulin formulations. This study compares levels of coverage and copays by private and Medicare Part D plans for insulin pens and vials containing basal insulin analogs and for NPH formulations in vials.

Methods: A commercially available formulary database (Access Point, Pinsonault Associates; updated quarterly) was analyzed as of January 2010 for private insurance plans and as of March 2010 for Medicare Part D plans. Analyses were performed for Tier-level coverage and copays per prescription for basal insulin analogs in pens and vials, and NPH in vials.

Results: Basal insulin analogs in pens were covered by >91% of private and Part D plans. NPH coverage was reported by >92% of private plans and 69-95% of Part D plans, depending on brand. Irrespective of delivery mode, copays in the majority of private plans for basal insulin analogs and NPH were in the >$10-35 range. Copays were higher in Part D plans, with the majority of plans and subscribers in a >$35-50 range. Prior authorization was required by <10% of insurance plans for insulin analog pen prescriptions, and <3% of plans for insulin analog or NPH prescriptions in vials.

Limitations: This analysis was descriptive, copay stratification was not based on a statistical model but on copay ranges typically used by the plans, and there were no direct correlations performed on the numbers of subscribers per plan vs copay or Tier level.

Conclusion: These results counter the widely held perception that insurance coverage is less extensive for insulin pens vs vials. Medicare Part D plans often had higher copay requirements than private plans for the same product at the same copay Tier.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3111/13696998.2011.613975DOI Listing
March 2012

Adherence and persistence to a regimen of basal insulin in a pre-filled pen compared to vial/syringe in insulin-naïve patients with type 2 diabetes.

Curr Med Res Opin 2011 Sep 11;27(9):1709-17. Epub 2011 Jul 11.

OptumInsight, Eden Prairie, MN 55344, USA.

Objective: This study was conducted to compare adherence and persistence of patients initiating basal insulin therapy with Levemir FlexPen versus those initiating basal insulin therapy with NPH via vial and syringe.

Materials And Methods: Data were gathered from a large US retrospective claims database, and included patients with type 2 diabetes that initiated basal insulin therapy with either Levemir FlexPen or NPH in vials. Patients were defined as adherent to therapy if they had a medication possession ratio (MPR) of ≥80% in the 12-month follow-up period and were defined as persistent with therapy if they had no gaps in insulin therapy in the follow-up period.

Results: After controlling for confounders using logistic regression, patients initiating therapy with Levemir FlexPen had 39% higher adjusted odds of achieving an MPR ≥80% versus patients initiating therapy with NPH vial (OR 1.39; 95% CI: 1.04-1.85). Analysis of persistence using a Cox proportional hazards model indicated that patients initiating Levemir FlexPen had a 38% lower hazard of discontinuation compared to NPH vial (HR 0.62, 95% CI: 0.55-0.70).

Limitations: Claims-based studies are limited to the extent that they accurately capture medical and pharmacy use. Also, relying on claims-based data limits the generalizability of the findings to similar populations and treatments.

Conclusions: These results suggest that persistence and adherence with insulin may be improved for patients initiating basal insulin therapy with Levemir FlexPen versus NPH vial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1185/03007995.2011.598500DOI Listing
September 2011

Economic benefits of improved insulin stability in insulin pumps.

Manag Care 2011 May;20(5):42-7

Purpose: Insulin pump users discard unused medication and infusion sets according to labeling and manufacturer's instructions. The stability labeling for insulin aspart (rDNA origin] (Novolog) was increased from two days to six. The associated savings was modeled from the perspective of a hypothetical one-million member health plan and the total United States population.

Design: The discarded insulin volume and the number of infusion sets used under a two-day stability scenario versus six were modeled.

Methods: A mix of insulin pumps of various reservoir capacities with a range of daily insulin dosages was used. Average daily insulin dose was 65 units ranging from 10 to 150 units. Costs of discarded insulin aspart [rDNA origin] were calculated using WAC (Average Wholesale Price minus 16.67%). The cost of pump supplies was computed for the two-day scenario assuming a complete infusion set change, including reservoirs, every two days. Under the six-day scenario complete infusion sets were discarded every six days while cannulas at the insertion site were changed midway between complete changes. AWP of least expensive supplies was used to compute their costs.

Principal Findings: For the hypothetical health plan (1,182 pump users) the annual reduction in discarded insulin volume between scenarios was 19.8 million units. The corresponding cost reduction for the plan due to drug and supply savings was $3.4 million. From the U.S. population perspective, savings of over $1 billion were estimated.

Conclusions: Using insulin that is stable for six days in pump reservoirs can yield substantial savings to health plans and other payers, including patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
May 2011

Evidence linking hypoglycemic events to an increased risk of acute cardiovascular events in patients with type 2 diabetes.

Diabetes Care 2011 May 18;34(5):1164-70. Epub 2011 Mar 18.

Thomson Reuters, Washington, District of Columbia, USA.

Objective: This retrospective study examined the association between ICD-9-CM-coded outpatient hypoglycemic events (HEs) and acute cardiovascular events (ACVEs), i.e., acute myocardial infarction, coronary artery bypass grafting, revascularization, percutaneous coronary intervention, and incident unstable angina, in patients with type 2 diabetes.

Research Design And Methods: Data were derived from healthcare claims for individuals with employer-sponsored primary or Medicare supplemental insurance. A baseline period (30 September 2006 to 30 September 2007) was used to identify eligible patients and collect information on their clinical and demographic characteristics. An evaluation period (1 October 2007 to 30 September 2008) was used to identify HEs and ACVEs. Patients aged ≥ 18 years with type 2 diabetes were selected for analysis by a modified Healthcare Effectiveness Data and Information Set algorithm. Data were analyzed with multiple logistic regression and backward stepwise selection (maximum P = 0.01) with adjustment for important confounding variables, including age, sex, geography, insurance type, comorbidity scores, cardiovascular risk factors, diabetes complications, total baseline medical expenditures, and prior ACVEs.

Results: Of the 860,845 patients in the analysis set, 27,065 (3.1%) had ICD-9-CM-coded HEs during the evaluation period. The main model retained 17 significant independent variables. Patients with HEs had 79% higher regression-adjusted odds (HE odds ratio [OR] 1.79; 95% CI 1.69-1.89) of ACVEs than patients without HEs; results in patients aged ≥65 years were similar to those for the entire population (HE OR 1.78, 95% CI 1.65-1.92).

Conclusions: ICD-9-CM-coded HEs were independently associated with an increased risk of ACVEs. Further studies of the relationship between hypoglycemia and the risk of ACVEs are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2337/dc10-1915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114512PMC
May 2011

Concurrent control of blood glucose, body mass, and blood pressure in patients with type 2 diabetes: an analysis of data from electronic medical records.

Clin Ther 2011 Jan;33(1):110-20

Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA.

Objective: This cross-sectional study describes glycemic, body mass, and blood pressure (BP) control in patients with type 2 diabetes mellitus (T2DM) in an ambulatory care-based database of electronic medical records (EMRs).

Methods: Patients aged ≥18 years with T2DM documented in 2008 and with glycosylated hemoglobin (HbA(1c)) value, body mass index (BMI), and BP charted within 90 days before or after T2DM documentation were identified using the General Electric Centricity EMR research database. Control of glycemia (controlled, <7.0%; uncontrolled, ≥7.0% [intermediate, 7.0%- <9.0%; poor, ≥9.0%]), body mass (nonobese, <30 kg/ m(2); obese, ≥30 kg/m(2) [intermediate, 30-<35 kg/m(2); poor, ≥35 kg/m(2)]), and BP (controlled, <130/<80 mm Hg; uncontrolled, ≥130/≥80 mm Hg [intermediate, 130-<160/80-<100 mm Hg; poor, ≥160/≥100 mm Hg]) was identified, and patients were stratified by level of control individually and in combination. Comorbidities and antidiabetic and antihypertensive treatments prescribed in the year before the index date were identified in the EMR.

Results: The mean (SD) age of the cohort (N = 49,560) was 60.9 (12.4) years; 51.5% were female. A minority had controlled glycemia (36.4%), body mass (30.2%), and/or BP (36.4%). Of those with controlled glycemia and body mass, 44.8% also had controlled BP, representing 5.5% of the overall study population.

Conclusions: Despite the potential selection bias, a minority of patients in this cross-sectional study were at HbA(1c), BP, or BMI goals, and even fewer gained control of all 3 of these risk factors. More intensive T2DM treatment with complementary efforts to manage body mass and BP is warranted in this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinthera.2011.01.018DOI Listing
January 2011

Human growth hormone treatment: synthesis of literature on product delivery systems and administration practices.

J Spec Pediatr Nurs 2011 Jan;16(1):50-63

I.M.S. Health, Health Economics and Outcomes Research, Falls Church, Virginia, USA.

Purpose: To synthesize current literature on recombinant human growth hormone (rhGH) use and to identify areas of research that have received little to no attention in light of administration practice and patient perception/behavior.

Design And Methods: Relevant articles for a systematic review were identified through PubMed.

Results: A total of 43 articles were identified: 9 (15.9%) studies on product administration practices and 34 (84.1%) on patient behavior patterns. Patients primarily preferred simple, convenient, and easy-to-use delivery devices. However, literature addressing the effect of convenient product administration practices on treatment outcomes using real-world patient/caregiver data is lacking.

Practice Implications: Better understanding of real-world product administration practices will help nurses identify areas of improvement in patient education and training.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1744-6155.2010.00267.xDOI Listing
January 2011

Association between glycemic control and short-term healthcare costs among commercially insured diabetes patients in the United States.

J Med Econ 2011 11;14(1):108-14. Epub 2011 Jan 11.

Novo Nordisk Inc, Princeton, NJ, USA.

Unlabelled: Abstract Objectives: Glycemic control, measured by HbA(1c), is well known to be a risk marker for long-term costly diabetes-related complications. The relationship between HbA(1c) and short-term costs is unclear. This study investigates how HbA(1c) is correlated to short-term diabetes-related medical expenses.

Methods: Patients with diabetes with an HbA(1c) reading ≥6% between April and September 2007 were identified from a large US managed-care organization. Healthcare utilization data was obtained during the subsequent 12-month period. Multivariate analyses were performed to estimate the correlation between HbA(1c) and diabetes-related healthcare costs.

Results: In all, 34,469 and 1,837 patients with type 2 and type 1 diabetes, respectively, were identified with an HbA(1c) reading ≥6% (mean HbA(1c): 7.4% and 7.9%). The majority of patients with type 1 diabetes were treated with insulin, while most patients with type 2 diabetes were treated with metformin. The multivariate analysis showed that several characteristics, including HbA(1c), significantly correlate with diabetes-related medical costs for both patients with type 1 and type 2 diabetes. A 1-percentage-point increase in HbA(1c) will, on average, lead to a 6.0% and 4.4% increase in diabetes-related medical costs for type 1 and type 2 diabetes, respectively. This corresponds to an annual cost increase of $445 and $250 for patients with type 1 and type 2 diabetes, respectively.

Limitations: Retrospective data analyses inherently associated with selection bias which can only partly be adjusted by statistical techniques. Furthermore, the study population is not necessarily representative of the general population and there can be isolated coding or data errors in the dataset.

Conclusions: These results suggest that tighter glycemic control is associated with short-term cost benefits for patients with diabetes. This supplements conventional wisdom that HbA(1c) affects risk of long-term complications and long-term costs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3111/13696998.2010.548432DOI Listing
June 2011

Does type of bolus insulin matter in the hospital? Retrospective cohort analysis of outcomes between patients receiving analogue versus human insulin.

Clin Ther 2010 Oct;32(11):1954-66

Cerner LifeSciences, Beverly Hills, California, USA.

Background: Poor glycemic control in hospitalized patients has been associated with increased morbidity and mortality. Research suggests that analogue bolus insulin may be more effective in achieving blood glucose (BG) control compared with human bolus insulin.

Objective: This study compares mortality, length of stay (LOS), costs, and BG control in hospitalized patients receiving either analogue or human bolus insulin.

Methods: This retrospective cohort analysis used data from January 1, 2004, to December 31, 2007, within the Health Facts database (Cerner Corporation, Kansas City, Missouri). Nonsurgical adult patients who received exclusively analogue or human bolus insulin during hospitalization were included in the study. Propensity score matching and multivariate regression analyses were used to compare patients treated with analogue versus human bolus insulin. The study outcomes were in-hospital mortality, hospital LOS among survivors (to avoid potentially short hospitalizations among nonsurvivors distorting results), and hospitalized BG control (present vs absent), defined as having a mean BG of 70 to <200 mg/dL during hospitalization.

Results: In total, 35,049 participants met the inclusion criteria and 5568 of 7754 patients in the analogue group were matched by their propensity scores to patients in the human bolus group (mean age, 67.1 years; 53% women; 77% white). On propensity score analysis, analogue bolus insulin was associated with lower mortality (relative risk [RR] = 0.52; 95% CI, 0.45-0.61) and shorter LOS (0.668-day reduction; 95% CI, 0.44-0.89) compared with human bolus insulin. However, analogue insulin was associated with only a modest benefit for BG control (RR = 0.88; 95% CI, 0.81-0.95). The multivariate regression analysis produced similar findings.

Conclusions: In this cohort of hospitalized patients, analogue bolus insulin was associated with lower mortality, shorter LOS, and modestly better BG control compared with patients treated with human bolus insulin. These results highlight the need for a randomized controlled clinical trial comparing outcomes by bolus insulin type in the hospital setting to determine a true mortality benefit.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinthera.2010.10.009DOI Listing
October 2010

Evaluation of the long-term cost-effectiveness of insulin detemir compared with neutral protamine hagedorn insulin in patients with type 1 diabetes using a basal-bolus regimen in Sweden.

Scand J Public Health 2011 Feb 5;39(1):79-87. Epub 2010 Aug 5.

Ossian Health Economics and Communication, Basel, Switzerland.

Aims: To evaluate the long-term clinical and economic outcomes associated with insulin detemir and neutral protamine hagedorn (NPH) insulin in combination with mealtime insulin aspart in patients with type 1 diabetes in Sweden, based on data from a two-year, multi-national, open-label, randomized, controlled trial.

Methods: Insulin detemir was associated with significant improvements in glycaemic control after 24 months (HbA1c 7.36% versus 7.58%, mean difference -0.22%, p = 0.022) and major hypoglycaemic events (69% risk reduction, p = 0.001) versus NPH. Patients treated with detemir gained less weight (1.7 versus 2.7 kg, P = 0.024). Based on these findings, a published and validated computer model (IMS CORE Diabetes Model) was used to estimate life-expectancy, quality-adjusted life expectancy and both direct medical costs and indirect costs.

Results: Basal-bolus therapy with insulin detemir was projected to improve life expectancy by 0.14 years (15.02 ± 0.19 versus 14.88 ± 0.18 years) and quality-adjusted life expectancy by 0.53 quality-adjusted life years (QALYs) versus NPH (8.35 ± 0.11 versus 7.82 ± 0.10 QALYs). Improvements in QALYs were driven by avoided or delayed diabetes-related complications and fewer hypoglycaemic events. Direct medical costs over patient lifetimes were SEK 26,144 higher in the insulin detemir arm (SEK 995,025 ± 19,580 versus 968,881 ± 19,769), leading to an incremental cost-effectiveness ratio of SEK 49,757 per QALY gained. Capturing indirect costs led to insulin detemir being cost saving over patient lifetimes, by SEK 80,113, compared to NPH (SEK 2,959,909 ± 64,727 versus 3,040,022 ± 62,317).

Conclusions: Compared with NPH, insulin detemir is likely to be cost-effective from a healthcare payer perspective and dominant from a societal perspective in patients with type 1 diabetes in Sweden.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1403494810379290DOI Listing
February 2011

Cost of diabetes: comparison of disease-attributable and matched cohort cost estimation methods.

Curr Med Res Opin 2010 Aug;26(8):1827-34

HealthCore, Inc., Wilmington, DE 19801-1366, USA.

Objective: To estimate and compare the annual direct healthcare cost among Type 1 (T1DM) and Type 2 (T2DM) diabetes patients using two cost estimation methods: (1) DM-attributable cost and (2) all cause case-control cost.

Research Design And Methods: An administrative claims cohort study using the HealthCore Integrated Research Database (HIRD(R)) identified T1DM and T2DM patients age >or=18 and <65 years between 1/1/2006 - 12/31/2006. DM patients (cases) were matched 1:1 with non-DM patients (controls) by age, gender, state, and commercial plan type (HMO, PPO, POS). All patients had continuous eligibility for calendar years 2006-07. DM-attributable cost was assessed by summing medical claims for DM (ICD-9-CM codes 250.xx) and pharmacy claims for anti-hyperglycemic agents, and all cause health care cost was assessed for cases and controls, for the calendar year 2007.

Results: A total of 12,096 T1DM and 256,245 T2DM cases and matched controls were identified. T1DM and T2DM cases had significantly higher average baseline comorbidities and Deyo-Charleson Comorbidity scores than controls (2.17 vs. 0.23 and 1.62 vs. 0.39, respectively, p < 0.0001 for both).While DM attributable cost estimation resulted in a mean annual cost of $6247 for T1DM and $3002 for T2DM in 2007, the mean annual (per patient) all-cause total cost estimation using the case-control method resulted in a difference of $10,837 ($14,060 for cases, vs. $3223 for controls) for T1DM; and $4217 ($8070 for cases, vs. $3853 for controls) for T2DM.

Conclusions: The DM-attributable cost method underestimated costs by 42% for T1DM and 29% for T2DM compared to the case-control method. The difference was smaller but still significant (33% for T1DM and 14% for T2DM) when multivariate technique was used. Patients with DM may use a substantial amount of medical and pharmacy services not directly attributable to DM, and attributable cost method may underestimate the total cost of DM. This study has limitations inherent to the retrospective claims data analysis and generalizability of results is limited to those from similar population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1185/03007995.2010.488544DOI Listing
August 2010

Assessment of adherence and healthcare costs of insulin device (FlexPen) versus conventional vial/syringe.

Adv Ther 2010 Feb 26;27(2):94-104. Epub 2010 Mar 26.

The University of Michigan and STATinMED Research, 218 N. Fourth Avenue, Ann Arbor, MI 48104, USA.

Introduction: Diabetes is difficult to manage and treatment involves significant lifestyle adjustments. Unlike the traditional method of insulin administration via the vial and syringe method, insulin pens might be perceived as less cumbersome and have potential to significantly increase patient adherence.

Methods: Using "real world" data, we examined the differences in adherence and costs between diabetic patients using an insulin FlexPen (Novo Nordisk Inc, Princeton, NJ, USA) and those using traditional vial and syringe administration. Using a retrospective analysis of health insurance claims data between the years 2003 and 2008, we examined patients in the FlexPen cohort and analog vial cohort. Propensity score matching was used to match these cohorts (n=532 in each) according to baseline characteristics.

Results: Adjusted mean medication possession ratio when switched to FlexPen improved by 22 percentage points versus 13 percentage points when continuing to use vials (P=0.001). Diabetes-related healthcare costs when switched to FlexPen versus continuing on to use vials ($3970 vs. $4838, respectively, P=0.9368) and total healthcare costs ($13,214 vs. $13,212, respectively, P=0.9473) were not statistically different.

Conclusion: Without significant addition to the cost, insulin administration with FlexPen is associated with an improved adherence among patients who switched from vial-based insulin administration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12325-010-0009-6DOI Listing
February 2010

Cost-effectiveness of switching to biphasic insulin aspart from human premix insulin in a US setting.

J Med Econ 2010 ;13(2):212-20

IMS Health, CORE–Center for Outcomes Research GmbH, Gewerbestrasse 25, Allschwil, Switzerland.

Objectives: To evaluate the cost-effectiveness of switching to biphasic insulin aspart (BIAsp 30) from human premix insulin for type 2 diabetes patients in the United States (US) setting.

Methods: The previously published and validated IMS Core Diabetes Model was used to project life expectancy, quality-adjusted life expectancy (QALE) and costs over 30 years. Patient characteristics and treatment effects were based on Canadian patients included the IMPROVE observational study (n = 311). Mean glycohaemoglobin (HbA(1c)) was 8.4%, duration of diabetes 16 years and prevalence of complications high at baseline. Simulations were conducted from the perspective of a third-party payer, with costs accounted in 2008 US dollars ($).

Results: BIAsp 30 was projected to improve life expectancy by 0.202 years and QALE by 0.301 quality-adjusted life-years (QALYs), due to a reduced incidence of most diabetes-related complications. BIAsp 30 was associated with increased lifetime direct medical costs ($76,517 vs. 67,518) and an incremental cost-effectiveness ratio of $29,870 per QALY gained. Long-term outcomes were sensitive to the impact of BIAsp 30 on hypoglycaemia and changes in HbA(1c).

Conclusions: BIAsp 30 may represent a cost-effective treatment option in the US setting for advanced type 2 diabetes patients experiencing poor glycaemic control or hypoglycaemia on human premix insulin.

Limitations: The application of treatment effect data derived from a Canadian cohort to the US setting was a limitation of the cost-effectiveness analysis. The findings of this cost-effectiveness analysis are not applicable to insulin-naïve diabetes patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3111/13696991003723999DOI Listing
April 2011

Healthcare utilization changes in relation to treatment intensification with insulin aspart in patients with type 2 diabetes. Data from a large US managed-care organization.

J Med Econ 2010 Mar;13(1):16-22

Novo Nordisk Inc., Princeton, NJ, USA.

Objective: Most patients with type 2 diabetes eventually require exogenous insulin therapy to achieve good glycemic control due to the progressive nature of the disease. Insulin aspart is a rapid-acting insulin analog developed for prandial use. This study aimed to illustrate the implications on healthcare costs of adding insulin aspart to basal therapy in a real-world setting.

Methods: Patients with type 2 diabetes who intensified previous basal therapy with insulin aspart were identified from a large commercial US healthcare data source between April 2007 and September 2008. Patients were required to have received basal insulin treatment with or without concomitant oral antidiabetic (OAD) therapy for at least 90 days pre- and post-initiation of insulin aspart. Wilcoxon signed-rank test and McNemar's test were used for continuous and categorical variables, respectively, to analyze the difference of self-comparison between pre- and post insulin aspart add-on.

Results: In total, 1,739 patients with an average age of 56 years were identified, of whom 55% were male. After initiation of insulin aspart, a significant improvement in glycemic control was observed (change in HbA(1c): -0.5%, p=0.0013). Similarly, a reduction of 0.4% in HbA(1c) was observed for the subpopulation of 151 patients, who had both pre-and post-index HbA(1c) data (p=0.0085). Also, significantly fewer patients used OADs after insulin aspart initiation (56 vs. 64%, p< 0.0001). Overall and diabetes-related healthcare costs also significantly decreased by $2,283 and $2,028, respectively (p≤ 0.0001). Diabetes-related inpatient visits appear to be the main contributor to total cost (46%); however, after initiation of insulin aspart the number of inpatient visits decreased by 0.50 visits/patient/year (p< 0.05). This decrease was reflected in a large reduction in cost related to inpatient visits ($3,019/patient).

Limitations: A regression to the mean effect may be associated with this pre-post comparison. The ability to make conclusions regarding cause and effect may be limited due to the retrospective design of this study.

Conclusions: Patients with type 2 diabetes achieved better glycemic control and needed less OAD treatment after adding insulin aspart to previous basal therapy. Furthermore, patients experienced on average reduced healthcare utilization after initiation of insulin aspart, which resulted in significant cost savings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3111/13696990903485154DOI Listing
March 2010

Direct health care costs of patients with type 2 diabetes within a privately insured employed population, 2000 and 2005.

J Occup Environ Med 2009 Dec;51(12):1460-5

Healthcare & Science Department, Thomson Reuters, Washington, DC, USA.

Objective: To assess the incremental economic burden of privately insured patients with type 2 diabetes (T2DM) in 2000 and 2005 in the United States.

Methods: Adults with T2DM and 24 months of continuous health plan enrollment were identified in the MarketScan databases (2000 and 2005). Control groups of persons without diabetes were selected for comparison using propensity score matching. Total adjusted health care costs were estimated using generalized linear modeling.

Results: Adjusted health care costs of patients with T2DM in 2005 were 136% higher than those of the matched controls ($12,733 vs $5406, P < 0.001). Similarly, costs of patients with T2DM in 2000 were 146% higher than those of the matched controls ($12,423 vs $5058, P < 0.001). Expenditures were similar for individuals with T2DM in 2000 and 2005.

Conclusions: T2DM continues to impose a substantial economic burden to self-insured employers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JOM.0b013e3181c2bb31DOI Listing
December 2009

Comparison of daily insulin dose and other antidiabetic medications usage for type 2 diabetes patients treated with an analog basal insulin.

Curr Med Res Opin 2010 Jan;26(1):191-201

University of Utah Department of Pharmacotherapy, Salt Lake City, Utah 84108, USA.

Objective: Few comparisons of real-world insulin detemir (DET) and insulin glargine (GLAR) utilization have been conducted, which would assist payers and other healthcare decision makers assess the cost effectiveness of these treatment alternatives. The aim of this study was to compare the amount of insulin utilized in a large cohort of patients with type 2 diabetes treated with either DET or GLAR in the real-world setting considering the use of other antidiabetic agents.

Research Design And Methods: A nested case-control study was conducted using data from a large US medical and pharmacy claims data warehouse. Adults with type 2 diabetes newly treated with DET or GLAR were included. From this overall cohort, a subset of DET patients were matched 1:1 to GLAR on age, baseline antidiabetic use, and comorbidities. Descriptive statistics were used to compare patient characteristics between treatment groups; a Wilcoxon rank sum test was used to compare insulin utilization in terms of the patient level daily average consumption (DACON).

Main Outcomes Measures: Mean DACON by analog basal insulin.

Results: This study included 18,763 patients; 2215 (11.8%) were treated with DET and 16,548 (88.2%) with GLAR. DET patients were slightly younger (59.6 vs. 60.3 years; p < or = 0.01); gender did not differ (46% female). From the overall cohort, 1581 DET patients were matched to 1581 GLAR patients. Mean (median) DACON did not differ overall (35 [26] units for DET vs. 32 [27] units for GLAR; p = 0.06) or in the matched cohort (35 [26] units for DET vs. 32 [27] units for GLAR; p = 0.146). In the matched cohort, there were no differences in non-insulin antidiabetic use after DET or GLAR was started.

Conclusions: In a real-world setting, insulin utilization did not differ between DET and GLAR controlling for patient characteristics and considering concomitant antidiabetic treatments, which could influence insulin use. A limitation is that the dispensing data as used in this study may not accurately reflect daily insulin dose because patients may discard unused insulin portions when the vial or pre-filled syringe reaches its in-use expiration date. Additional research is warranted to determine if there are differences in DET and GLAR utilization over time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1185/03007990903432470DOI Listing
January 2010

Cost-effectiveness of insulin detemir compared with neutral protamine Hagedorn insulin in patients with type 1 diabetes using a basal-bolus regimen in five European countries.

J Med Econ 2009 Jun;12(2):114-23

IMS Health, Allschwil/Basel, Switzerland.

Objectives: The aim of this analysis was to evaluate the long-term clinical and economic outcomes associated with insulin detemir and neutral protamine Hagedorn (NPH) insulin in combination with mealtime insulin aspart in patients with type 1 diabetes in Belgian, French, German, Italian and Spanish settings.

Methods: The published and validated IMS CORE Diabetes Model was used to make long-term projections of life expectancy, quality-adjusted life expectancy and direct medical costs. The analysis was based on patient characteristics and treatment effects from a 2-year randomised controlled trial. Events were projected for a time horizon of 50 years. Potential uncertainty using a modelling approach was addressed.

Results: Basal-bolus therapy with insulin detemir was projected to improve quality-adjusted life expectancy by 0.45 years versus NPH in the German setting, with similar improvements in the other countries. Insulin detemir was associated with cost savings in Belgium, Germany and Spain. In France and Italy, lifetime costs were slightly higher in the detemir arm, leading to incremental cost-effectiveness ratios of 519 euro per QALY gained and 3,256 euro per QALY gained, respectively.

Conclusions: Compared to NPH, insulin detemir is likely to be a dominant treatment strategy in Belgium, Germany and Spain and highly cost-effective in France and Italy in patients with type 1 diabetes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3111/13696990903080344DOI Listing
June 2009

A comparison of insulin use, glycemic control, and health care costs with insulin detemir and insulin glargine in insulin-naive patients with type 2 diabetes.

Clin Ther 2009 Mar;31(3):623-31

Health Economics and Outcomes, i3 Innovus, Eden Prairie, Minnesota 55344, USA.

Objectives: The goal of this study was to compare daily insulin use, glycemic control, and health care costs in insulin-naive patients with type 2 diabetes who initiated treatment with either insulin detemir or insulin glargine.

Methods: This was a retrospective cohort analysis of health care claims data and laboratory results for adult, insulin-naive patients with type 2 diabetes who were enrolled in a large US managed care organization and initiated basal therapy with insulin detemir or insulin glargine between May 1, 2006, and December 31, 2006. The daily average consumption (DACON) of insulin was calculated as the total number of units dispensed (excluding the last fill) divided by the number of days between the index date and the date of the last fill of the index insulin. Glycemic control was evaluated by comparing mean glycosylated hemoglobin (HbA(1c)) values in the preindex period (the 180 days before the index date) and the follow-up period (the 180 days after the index date). Mean all-cause and diabetes-related health care costs in the preindex and follow-up periods were calculated and compared.

Results: The analysis included 48 patients initiating therapy with insulin detemir and 258 initiating therapy with insulin glargine. The mean age of the 2 cohorts was approximately 54 years, and most patients in each cohort were male (52.1% and 59.7%, respectively). Few patients in either cohort had a baseline HbA(1c) value <7% (13% and 10%), suggesting poor glycemic control at the time of insulin initiation. After adjustment for confounders (eg, preindex diabetes medication), the DACON of insulin was comparable between cohorts (29.3 and 29.6 U/d; P = NS), as were follow-up HbA(1c) values (8.2% and 7.9%). Insulin detemir and insulin glargine also were associated with comparable mean adjusted all-cause pharmacy costs ($3074 and $2899), medical costs ($2319 and $3704), and total health care costs ($6014 and $7023). However, insulin glargine was associated with significantly higher mean adjusted diabetes-related medical costs compared with insulin detemir ($1510 vs $707, respectively; P = 0.03), as well as significantly higher mean adjusted total diabetes-related health care costs ($3408 vs $2261; P = 0.03).

Conclusions: In this managed care population of insulin-naive patients who initiated therapy with insulin detemir or insulin glargine, the daily insulin dose and glycemic control did not differ significantly between the 2 insulins. However, patients receiving insulin detemir incurred lower diabetes-related medical and total health care costs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinthera.2009.03.005DOI Listing
March 2009

Indirect comparison of once daily insulin detemir and glargine in reducing weight gain and hypoglycaemic episodes when administered in addition to conventional oral anti-diabetic therapy in patients with type-2 diabetes.

Pharmacology 2008 1;82(2):156-63. Epub 2008 Aug 1.

IMS Health, London, UK.

Aims: Basal insulin administered to type-2 diabetic patients with poor glycaemic control when managed with oral anti-diabetics (OADs) alone can lead to an increased risk of weight gain and hypoglycaemia. In the absence of head-to-head trials, an indirect comparison of the once-daily insulin detemir with insulin glargine was conducted on the following outcomes: weight gain, hypoglycaemic episodes, and HbA(1c).

Methods: Parallel-group randomised controlled trials of at least 20 weeks duration that compared once-daily evening glargine or detemir with a common comparator, neutral protamine Hagedorn insulin (evening), were selected. Trials focused on insulin-naïve, type-2 diabetic patients poorly controlled with OAD. Five open-label trials were identified (n = 2,092 patients; n = 1 detemir and n = 4 glargine trials), with an indirect comparison of glargine (n = 869 patients) and detemir trials (n = 169 patients) carried out using meta-regression to control for covariates. Weight gain was analysed as weighted mean differences (WMD), hypoglycaemic episodes as odds ratios (OR), and HbA(1c) at the end of study as standardised mean differences (SMD).

Results: Patients receiving evening detemir gained significantly less weight (unadjusted WMD -1.22 kg, 95% CI -2.15, -0.29 kg; p = 0.010) and significantly fewer of them experienced hypoglycaemic episodes versus evening glargine (unadjusted OR 0.52, 95% CI 0.28, 0.98; p = 0.044). There was no significant difference between treatments for the mean HbA(1c) level at study endpoint (unadjusted SMD 0.09, 95% CI -0.16, 0.33; p = 0.480).

Conclusions: Once-daily use of insulin detemir resulted in significantly less weight gain and fewer hypoglycaemic episodes than glargine, while maintaining clinically appropriate HbA(1c) levels in type-2 diabetic patients currently receiving OAD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000149569DOI Listing
October 2008

Evaluating the cost-effectiveness of therapy conversion to insulin detemir in patients with type 2 diabetes in Germany: a modelling study of long-term clinical and cost outcomes.

Adv Ther 2008 Jun;25(6):567-84

IMS Health Economics and Outcomes Research, Gewerbestrasse 25, 4123 Allschwil, Basel, Switzerland.

Objectives: To evaluate the long-term cost-effectiveness of transferring type 2 diabetes patients to an insulin detemir regimen after failure to achieve adequate control with oral antidiabetic agents (OADs) alone, or in combination with neutral protamine hagedorn (NPH) insulin, or with insulin glargine in Germany.

Methods: A computer simulation model of diabetes was used to make long-term projections of future clinical outcomes and direct medical costs based on findings from a German subanalysis of the PREDICTIVE trial. The study analysed the impact of converting patients failing their current treatments to an insulin detemir regimen. Therapy conversion to insulin detemir +/- OADs was associated with a significant reduction in glycosylated haemoglobin (HbA(1)c) compared with OADs alone, NPH insulin +/- OADs, and insulin glargine +/- OADs. Across all three groups, hypoglycaemia rates decreased by 80% and patients lost an average of 0.9 kg of body weight during treatment with insulin detemir +/- OADs.

Results: Therapy conversion to insulin detemir +/- OADs was projected to improve life expectancy by 0.28 years compared with OADs alone, and by 0.13 years compared with the NPH and glargine regimens. Transfer to insulin detemir was associated with improvements in quality-adjusted life expectancy of 0.21 quality-adjusted life years (QALYs) over OADs alone, 0.28 QALYs over NPH +/- OADs, and 0.29 QALYs over glargine +/- OADs. Insulin detemir was associated with savings over patient lifetimes due to reduced diabetes-related complications in all three comparisons.

Conclusions: Therapy conversion to insulin detemir +/- OADs in type 2 diabetes patients failing OADs alone, NPH or insulin glargine regimens was associated with improvements in life expectancy, quality-adjusted life expectancy and cost savings in all three scenarios evaluated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12325-008-0069-zDOI Listing
June 2008

The cost-effectiveness of bimatoprost, latanoprost and timolol in treatment of primary open angle glaucoma in five European countries.

Curr Med Res Opin 2006 May;22(5):897-905

Biot, France, Formerly of Allergan R&D Europe.

Objective: The objective of this cost-effectiveness analysis is to evaluate cost-effectiveness ratios of the intraocular pressure (IOP)-lowering agents bimatoprost, latanoprost and timolol in five major European countries: France, Germany, Italy, Spain and the UK.

Methods: The cost-effectiveness analysis is based on achievement of IOP targets between 13 and 18 mm Hg. Thus, the cost-effectiveness ratios express the costs of having one patient successfully achieving IOP target. The perspective of the analysis is that of the health care sector payer, including costs of medicine and costs of ophthalmologist visits. The time frame is first year of glaucoma treatment. Four treatment strategies are analysed: Timolol as first line with add-on latanoprost or bimatoprost if IOP targets are not met, and latanoprost and bimatoprost as first line with add-on timolol.

Results: In the UK, Spain, Italy and Germany the timolol first with add-on of bimatoprost is the least expensive treatment. This strategy dominates both strategies involving latanoprost (as add-on to timolol or as first line) in these four countries. The incremental cost-effectiveness ratio of bimatoprost first-line therapy versus timolol with add-on bimatoprost varies from each country and target (from 305 pounds sterlings to 43,720 euros per patient). In France the timolol first line and latanoprost add-on is not dominated and is the cheapest alternative. The incremental cost-effectiveness ratio of timolol with add-on bimatoprost versus add-on latanoprost lies between 71 euros and 355 euros per patient depending on target (18 and 13 mm Hg, respectively).

Conclusion: First-line treatment of latanoprost is dominated in all countries. In four out of five countries the timolol first-line therapy with add-on latanoprost is also dominated. Based on this pharmacoeconomic analysis, the most cost-effective strategy seems to be timolol first line with add-on bimatoprost if target is not met after 3 months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1185/030079906X104687DOI Listing
May 2006
-->