Eli Lilly and Company, Indianapolis, Indiana, USA.
Appl Health Econ Health Policy. 2009;7(4):245-54. doi: 10.1007/BF03256158.
Exenatide (Byetta) and insulin glargine (Lantus) are antidiabetic agents that are typically used after lack of response to an oral antidiabetic agent(s). Although previous research has examined the impact of these medications on glycaemic control, there is little information about the relative costs associated with the medications.
To compare costs among patients with type 2 diabetes mellitus treated with exenatide or insulin glargine from a US third-party payer perspective.
Data from a large, national administrative claims database were used in this study. The intent-to-treat (ITT) cohort included adults who were diagnosed with type 2 diabetes and initiated therapy with either exenatide (n = 4090) or insulin glargine (n = 1660). In addition, included patients were required to have no diagnoses of type 1 diabetes, to have received at least two prescriptions for an oral antidiabetic agent in the 6 months prior to first use of either exenatide or insulin glargine and to have continuous insurance coverage from 6 months before, to 12 months after, initiation on ITT medication. Annual total medical costs and total diabetes-related medical costs, in $US, year 2007 values, were estimated using stepwise multivariate regressions. Major cost components were also examined using either stepwise multivariate regressions or a two-part model that controlled for the probability of using the service. Smearing estimates were used to transform estimated log costs into costs. The analysis controlled for the potential impact of patient demographics, general health, prior resource use, co-morbidities and complications, and timing of treatment initiation.
Compared with insulin glargine, initiation of exenatide was associated with significantly lower total direct medical costs ($US19,293 vs $US23,782; p < 0.0001), inpatient costs ($US4121 vs $US7532; p < 0.0001), outpatient costs ($US9501 vs $US12,885; p < 0.0001), emergency department (ED) costs ($US82 vs $US131; p < 0.0001), total diabetes-related medical costs ($US7833 vs $US8536; p < 0.0001), diabetes-related inpatient costs ($US2172 vs $US3538; p < 0.0001) and diabetes-related outpatient costs ($US2739 vs $US3249; p < 0.0001). Initiation of exenatide was associated with significantly higher total overall drug costs ($US6885 vs $US5936; p < 0.0001) and diabetes-related drug costs ($US3160 vs $US2422; p < 0.0001).
Compared with the use of insulin glargine, use of exenatide was associated with significantly lower annual total direct medical costs and significantly lower total diabetes-related medical costs, despite higher total drug costs and higher diabetes-related drug costs. In addition, exenatide was associated with significantly lower total inpatient, outpatient, ED, and diabetes-related inpatient and outpatient costs.
艾塞那肽（百泌达）和甘精胰岛素（来得时）是两种抗糖尿病药物，通常在口服抗糖尿病药物治疗无效后使用。虽然之前的研究已经考察了这些药物对血糖控制的影响，但关于与这些药物相关的相对成本的信息却很少。
从美国第三方支付者的角度比较 2 型糖尿病患者使用艾塞那肽或甘精胰岛素的成本。
本研究使用了来自一个大型全国性行政索赔数据库的数据。意向治疗（ITT）队列包括被诊断患有 2 型糖尿病且开始接受艾塞那肽（n=4090）或甘精胰岛素（n=1660）治疗的成年人。此外，纳入的患者必须没有 1 型糖尿病的诊断，在开始使用艾塞那肽或甘精胰岛素之前的 6 个月内至少有两次口服抗糖尿病药物的处方，并且在 ITT 药物治疗开始前的 6 个月到治疗后 12 个月内连续有保险覆盖。使用逐步多元回归估计了 2007 年以美元计价的年度总医疗费用和糖尿病相关的总医疗费用。还使用逐步多元回归或控制服务使用概率的两部分模型检查了主要成本组成部分。使用涂抹估计值将估计的对数成本转换为成本。该分析控制了患者人口统计学、一般健康状况、既往资源使用、合并症和并发症以及治疗开始时间的潜在影响。
与甘精胰岛素相比，起始使用艾塞那肽与总直接医疗费用显著降低（$US19,293 比 $US23,782；p<0.0001）、住院费用（$US4121 比 $US7532；p<0.0001）、门诊费用（$US9501 比 $US12,885；p<0.0001）、急诊室（ED）费用（$US82 比 $US131；p<0.0001）、糖尿病相关的总医疗费用（$US7833 比 $US8536；p<0.0001）、糖尿病相关的住院费用（$US2172 比 $US3538；p<0.0001）和糖尿病相关的门诊费用（$US2739 比 $US3249；p<0.0001）显著降低。起始使用艾塞那肽与总整体药物费用显著升高（$US6885 比 $US5936；p<0.0001）和糖尿病相关药物费用（$US3160 比 $US2422；p<0.0001）显著升高有关。
与使用甘精胰岛素相比，尽管使用艾塞那肽的总药物费用和糖尿病相关药物费用更高，但使用艾塞那肽与显著降低的年度总直接医疗费用和显著降低的糖尿病相关医疗费用相关。此外，艾塞那肽与显著降低的总住院、门诊、ED 和糖尿病相关的住院和门诊费用相关。
