Pawaskar Manjiri D, Camacho Fabian T, Anderson Roger T, Cobden David, Joshi Ashish V, Balkrishnan Rajesh
Department of Pharmacy Practice and Administration, The Ohio State University College of Pharmacy, Columbus, Ohio 43210, USA.
Clin Ther. 2007;29 Spec No:1294-305.
Clinical, health, and economic outcomes in patients with type 2 diabetes may be influenced by self-management behaviors and type of pharmacotherapy.
This study examined differences in medication adherence and total health care costs among patients with type 2 diabetes who initiated or converted to insulin administration with a pen device in comparison with a vial/syringe as add-on therapy to oral antidiabetic drugs.
This study evaluated patients with type 2 diabetes who were enrolled in the North Carolina Medicaid program from September 24, 2001, to July 18, 2006. Patients receiving insulin with a vial/syringe who converted to pen therapy were compared with those who remained on vial/syringe in both unmatched comparisons (n = 560 and n = 9988, respectively) and after pair-matching (both cohorts, n = 560) with the use of propensity scores. In a second analysis, patients who initiated insulin with vial/syringe (n = 1162) were compared with a cohort that initiated insulin pen therapy (n = 168) after controlling for covariates in a multivariate regression model. All included patients had complete enrollment for at least 24 months of followup. Multiple linear regression models were used to predict the comparative impact on total health care costs and medication adherence for each cohort. Adjusted means were calculated to determine the group differences for each outcome.
Diabetes-related and overall medication adherence was comparable for patients initiating insulin with a pen versus a syringe (53% vs 50% and 94% vs 94%, respectively). However, total annualized health care costs were significantly lower for patients using pen therapy than for those using a syringe ($14,857.42 vs $31,764.78, respectively; P < 0.05). Cost reductions with pen therapy were reflected in hospital costs ($1195.93 vs $4965.31, respectively; P < 0.05), diabetes-related costs ($7324.37 vs $13,762.21, respectively; P < 0.05), and outpatient costs ($7795.98 vs $13,103.51, respectively; P < 0.05). However, prescription costs of syringe were significantly lower ($535.70 vs $670.52; P < 0.05) and costs of pen were higher ($840.33 vs $0; P < 0.05) in patients who were switched from syringe to pen versus those who remained on syringe therapy.
In a state Medicaid setting among patients with type 2 diabetes, initiating insulin therapy with a pen device was associated with comparable medication adherence and significant reductions in health care resource utilization and associated costs compared with vial/syringe insulin. Health care professionals and policy makers should consider the potential economic benefits of pen therapy when initiating insulin among Medicaid beneficiaries who fail to respond to oral antidiabetic drugs.
2型糖尿病患者的临床、健康及经济结局可能受自我管理行为和药物治疗类型的影响。
本研究比较了2型糖尿病患者起始或转换为笔式胰岛素注射与使用小瓶/注射器胰岛素作为口服降糖药附加治疗时的药物依从性及总体医疗费用差异。
本研究评估了2001年9月24日至2006年7月18日纳入北卡罗来纳医疗补助计划的2型糖尿病患者。在未匹配比较（分别为n = 560和n = 9988）以及使用倾向评分进行配对匹配后（两个队列，n = 560），将从小瓶/注射器胰岛素转换为笔式胰岛素治疗的患者与仍使用小瓶/注射器胰岛素的患者进行比较。在第二项分析中，在多变量回归模型中控制协变量后，将起始使用小瓶/注射器胰岛素的患者（n = 1162）与起始笔式胰岛素治疗的队列（n = 168）进行比较。所有纳入患者均至少有24个月的完整随访记录。使用多元线性回归模型预测每个队列对总体医疗费用和药物依从性的比较影响。计算调整均值以确定各结局的组间差异。
起始使用笔式胰岛素与注射器胰岛素的患者，糖尿病相关及总体药物依从性相当（分别为53%对50%和94%对94%）。然而，使用笔式胰岛素治疗的患者年化总体医疗费用显著低于使用注射器胰岛素的患者（分别为14,857.42美元对31,764.78美元；P < 0.05）。笔式胰岛素治疗的成本降低体现在住院费用（分别为1195.93美元对4965.31美元；P < 0.05）、糖尿病相关费用（分别为7324.37美元对13,762.21美元；P < 0.05）和门诊费用（分别为7795.98美元对13,103.51美元；P < 0.05）上。然而，从小瓶/注射器胰岛素转换为笔式胰岛素的患者，注射器的处方费用显著更低（535.70美元对670.52美元；P < 0.05），而笔式胰岛素的费用更高（840.33美元对0美元；P < 0.05），与仍使用注射器胰岛素治疗的患者相比。
在州医疗补助计划的2型糖尿病患者中，与小瓶/注射器胰岛素相比，起始笔式胰岛素治疗的药物依从性相当，且医疗资源利用及相关成本显著降低。医疗专业人员和政策制定者在为未对口服降糖药产生反应的医疗补助受益患者起始胰岛素治疗时，应考虑笔式胰岛素治疗的潜在经济效益。
