Nichols Gregory A, Reynolds Kristi, Olufade Temitope, Kimes Teresa M, O'Keeffe-Rosetti Maureen, Sapp Daniel S, Anzalone Deborah, Fortmann Stephen P
Kaiser Permanente Center for Health Research, Science Programs Department, Portland, Oregon.
Kaiser Permanente Southern California, Department of Research and Development, Pasadena, California.
Am J Cardiol. 2017 Feb 1;119(3):410-415. doi: 10.1016/j.amjcard.2016.10.029. Epub 2016 Nov 4.
High triglyceride (TG) levels among patients with type 2 diabetes mellitus (DM) are associated with higher medical costs. We analyzed the economic impact of TG-lowering therapies and whether the association between medical costs and therapy differed according to TG reduction. We conducted an observational cohort study of 184,932 patients with diabetes mellitus who had a TG measurement between January 2012 and June 2013 and a second TG measurement 3 to 15 months later. We identified 4 therapy groups (statin monotherapy, TG-specific monotherapy, statin/TG-specific combination therapy, or no therapy) and stratified those groups by percent change in TG (increased ≥5%, change of ≤4.9%, decreased 5% to 29%, decreased ≥30%). We compared change in medical costs between the year before and after therapy, adjusted for demographic and clinical characteristics. Of the 184,932 total patients, 143,549 (77.6%) received statin monotherapy, 900 (0.5%) received TG-specific monotherapy, 1,956 (1.1%) received statin and TG-specific combination therapy, and 38,527 (20.8%) received no prescription lipid agents. After covariate adjustment, statin/TG-specific agent recipients had a mean 1-year total cost reduction of $1,110. The greatest cost reduction was seen among statin/TG-specific combination therapy patients who reduced TG levels by ≥30% (-$2,859). Statin monotherapy patients who reduced TG by ≥30% also had a large reduction in adjusted costs (-$1,079). In conclusion, we found a substantial economic benefit to treating diabetic patients with statin/TG-specific combination lipid therapy compared with monotherapy of either type or no lipid pharmacotherapy. A TG reduction of ≥30% produced a particularly large reduction in 1-year medical costs.
2型糖尿病（DM）患者中高甘油三酯（TG）水平与更高的医疗费用相关。我们分析了降低TG治疗的经济影响，以及医疗费用与治疗之间的关联是否因TG降低情况而异。我们对184,932例糖尿病患者进行了一项观察性队列研究，这些患者在2012年1月至2013年6月期间进行了一次TG测量，并在3至15个月后进行了第二次TG测量。我们确定了4个治疗组（他汀类单药治疗、TG特异性单药治疗、他汀类/TG特异性联合治疗或未治疗），并根据TG的百分比变化（增加≥5%、变化≤4.9%、降低5%至29%、降低≥30%）对这些组进行分层。我们比较了治疗前后一年的医疗费用变化，并对人口统计学和临床特征进行了调整。在总共184,932例患者中，143,549例（77.6%）接受了他汀类单药治疗，900例（0.5%）接受了TG特异性单药治疗，1,956例（1.1%）接受了他汀类和TG特异性联合治疗，38,527例（20.8%）未接受处方降脂药物。经过协变量调整后，接受他汀类/TG特异性药物治疗的患者平均1年总费用降低了1,110美元。在TG水平降低≥30%的他汀类/TG特异性联合治疗患者中成本降低最大（-2,859美元）。TG降低≥30%的他汀类单药治疗患者调整后的成本也大幅降低（-1,079美元）。总之，我们发现与任何一种单药治疗或无降脂药物治疗相比，用他汀类/TG特异性联合降脂疗法治疗糖尿病患者具有显著的经济效益。TG降低≥30%可使1年医疗费用大幅降低。
