Williams Setareh A, Buysman Erin K, Hulbert Erin M, Bergeson Joette Gdovin, Zhang Bin, Graham John
AstraZeneca LP, 1800 Concord Pike, Wilmington, DE 19850, USA.
Manag Care. 2012 Jul;21(7):40-8.
To compare outcomes of type 2 diabetes mellitus (T2DM) patients initiating therapy with FDC vs. those with loose-dose combination (LDC) or step therapy (ST) in a managed care population.
A retrospective claims database analysis.
Treatment-naive T2DM patients who were continuously enrolled in a health plan during 2006-2009 were studied. Eligible patients were assigned to FDC, LDC, or ST cohorts. Glycated hemoglobin goal attainment (HbA1c < 7%) was assessed using the American Diabetes Association (ADA) treatment guidelines. Health care resources use and costs, including inpatient, emergency room (ER), and ambulatoryvisits, were measured during the 12 months after therapy initiation. All-cause and diabetes-related use and costs were assessed.
21,048 patients met study criteria (FDC n = 8,416, ST n = 8,407, LDC n = 4,225), and 1,926 of these patients had HbA1c results. FDC patients had lower rates of post-index all-cause inpatient stays and ER visits compared with the other cohorts. FDC patients had lower average counts of diabetes-related ambulatory visits (2.7) compared with ST (3.7; p < 0.001) and LDC (3.2; p < 0.001) and significantly lower average post-index all-cause and diabetes-related costs compared with the other cohorts, with average all-cause costs for FDC, ST, and LDC of $8,445, $10,515, and $9,688, respectively, and diabe-tes-related costs of $1,641, $2,099, and $1,900, respectively. FDC patients had higher rates of achieving HbA1c goal (61%) compared to ST (48%; p < 0.001) or LDC (52%; p = 0.015). Differences in outcomes remained following multivariate analyses.
Treatment with FDC was associated with lower health care resources use and costs and better likelihood of HbA1c goal attainment.
比较在管理式医疗人群中，起始使用固定剂量复方制剂（FDC）治疗的2型糖尿病（T2DM）患者与使用松散剂量联合治疗（LDC）或阶梯治疗（ST）的患者的治疗结果。
一项回顾性索赔数据库分析。
研究了2006 - 2009年期间持续参加健康计划的初治T2DM患者。符合条件的患者被分配到FDC、LDC或ST队列。根据美国糖尿病协会（ADA）治疗指南评估糖化血红蛋白达标情况（糖化血红蛋白<7%）。在治疗开始后的12个月内，测量医疗资源的使用和成本，包括住院、急诊室（ER）和门诊就诊。评估全因和糖尿病相关的使用情况及成本。
21,048例患者符合研究标准（FDC组n = 8,416，ST组n = 8,407，LDC组n = 4,225），其中1,926例患者有糖化血红蛋白结果。与其他队列相比，FDC组患者索引后全因住院和急诊就诊率较低。与ST组（3.7次；p < 0.001）和LDC组（3.2次；p < 0.001）相比，FDC组患者糖尿病相关门诊就诊平均次数较低（2.7次），且与其他队列相比，索引后全因和糖尿病相关平均成本显著更低，FDC组、ST组和LDC组的全因平均成本分别为8,445美元、10,515美元和9,688美元，糖尿病相关成本分别为1,641美元、2,099美元和1,900美元。与ST组（48%；p < 0.001）或LDC组（52%；p = 0.015）相比，FDC组患者达到糖化血红蛋白目标的比例更高（61%）。多变量分析后，结果差异仍然存在。
FDC治疗与更低的医疗资源使用和成本以及更高的糖化血红蛋白达标可能性相关。
