Marcum Zachary A, Driessen Julia, Thorpe Carolyn T, Donohue Julie M, Gellad Walid F
University of Pittsburgh, Pittsburgh, PA, USA
University of Pittsburgh, Pittsburgh, PA, USA.
Ann Pharmacother. 2015 Mar;49(3):285-92. doi: 10.1177/1060028014563951. Epub 2014 Dec 16.
When incretin mimetic (IM) medications were introduced in 2005, their effectiveness compared with other less-expensive second-line diabetes therapies was unknown, especially for older adults. Physicians likely had some uncertainty about the role of IMs in the diabetes treatment armamentarium. Regional variation in uptake of IMs may be a marker of such uncertainty.
To investigate the extent of regional variation in the use of IMs among beneficiaries and estimate the cost implications for Medicare.
This was a cross-sectional analysis of 2009-2010 claims data from a nationally representative sample of 238 499 Medicare Part D beneficiaries aged ≥65 years, who were continuously enrolled in fee-for-service Medicare and Part D and filled ≥1 antidiabetic prescription. Beneficiaries were assigned to 1 of 306 hospital-referral regions (HRRs) using ZIP codes. The main outcome was adjusted proportion of antidiabetic users in an HRR receiving an IM.
Overall, 29 933 beneficiaries (12.6%) filled an IM prescription, including 26 939 (11.3%) for sitagliptin or saxagliptin and 3718 (1.6%) for exenatide or liraglutide. The adjusted proportion of beneficiaries using IMs varied more than 3-fold across HRRs, from 5th and 95th percentiles of 5.2% to 17.0%. Compared with non-IM users, IM users faced a 155% higher annual Part D plan ($1067 vs $418) and 144% higher patient ($369 vs $151) costs for antidiabetic prescriptions.
Among older Part D beneficiaries using antidiabetic drugs, substantial regional variation exists in the use of IMs, not accounted for by sociodemographics and health status. IM use was associated with substantially greater costs for Part D plans and beneficiaries.
2005年引入肠促胰岛素类似物（IM）药物时，其与其他较便宜的二线糖尿病治疗方法相比的有效性尚不清楚，尤其是对老年人而言。医生可能对IM在糖尿病治疗手段中的作用存在一些不确定性。IM使用的地区差异可能是这种不确定性的一个标志。
调查受益人群中IM使用的地区差异程度，并估计对医疗保险的成本影响。
这是一项横断面分析，数据来自2009 - 2010年对238499名年龄≥65岁的医疗保险D部分受益人的全国代表性样本的索赔数据，这些受益人持续参加按服务收费的医疗保险和D部分，并开具了≥1张抗糖尿病处方。使用邮政编码将受益人分配到306个医院转诊区域（HRR）中的1个。主要结果是HRR中接受IM治疗的抗糖尿病药物使用者的调整比例。
总体而言，29933名受益人（12.6%）开具了IM处方，其中26939名（11.3%）使用西格列汀或沙格列汀，3718名（1.6%）使用艾塞那肽或利拉鲁肽。各HRR中使用IM的受益人的调整比例差异超过3倍，第5百分位数和第95百分位数分别为5.2%至17.0%。与未使用IM的用户相比，使用IM的用户每年的D部分计划费用（1067美元对418美元）高出155%，患者费用（369美元对151美元）高出144%。
在使用抗糖尿病药物的老年D部分受益人中，IM的使用存在显著的地区差异，社会人口统计学和健康状况无法解释这种差异。IM的使用与D部分计划和受益人的成本大幅增加相关。
