Lin Jay, Lingohr-Smith Melissa, Fan Tao
Health Economics and Outcomes Research, Novosys Health, Green Brook, NJ, USA.
North America Medical Affairs, Sanofi US, Inc., Bridgewater, NJ, USA.
Clinicoecon Outcomes Res. 2016 Dec 22;9:19-29. doi: 10.2147/CEOR.S117200. eCollection 2017.
Free-dose combination treatment with basal insulin and short-acting glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduces hyperglycemia via complementary targeting of fasting and postprandial blood glucose levels, however, in the real world, due to injection burden and clinical inertia, the full efficacy may not be able to translate into clinical and economic benefits.
The aim of the study was to evaluate treatment persistence and associated outcomes in patients with type 2 diabetes (T2D) treated with a GLP-1 RA in free-dose combination with basal insulin.
Claims data were extracted on US adults with T2D with ≥1 prescription claim for both a GLP-1 RA and a basal insulin from July 1, 2008 to June 30, 2013, and continuous health plan coverage for 6 months prior to (baseline) and 12 months after the index date (follow-up period). Outcomes analyzed for patients stratified by treatment persistence included glycemic control, hypoglycemia, and health care costs and resource utilization. Multivariate analyses were used to examine factors associated with persistence or hypoglycemia.
The analysis included 7,320 patients, of whom 16.9% were persistent with free-dose combination treatment. The median time to treatment discontinuation was 133 days. Compared with nonpersistent patients, persistent patients had greater glycated hemoglobin A1c (A1C) reductions (-0.80% vs -0.42%; =0.032), were more likely to achieve A1C <7.0% (39% vs 22%; <0.001), and were less likely to experience hypoglycemia (9.5% vs 6.8%; =0.002). Persistent patients also had significantly fewer hospitalizations and shorter hospital stays. While prescription costs were significantly higher (all-cause: $14,691 vs $10,791; <0.001; diabetes-related: $8,142 vs $5,124; <0.001), total medical charges were significantly lower (all-cause: $28,405 vs $40,292; =0.001; diabetes-related: $11,114 vs $15,203; =0.003) for persistent patients compared with nonpersistent patients.
This retrospective claims study of US patients with T2D showed that, although persistence with concurrent GLP-1 RA and basal insulin treatment is low, improved treatment persistence is associated with greater A1C reductions and lower total medical charges.
基础胰岛素与短效胰高血糖素样肽-1受体激动剂（GLP-1 RAs）的自由剂量联合治疗通过对空腹和餐后血糖水平的互补靶向作用降低高血糖，但在现实世界中，由于注射负担和临床惰性，其全部疗效可能无法转化为临床和经济效益。
本研究旨在评估接受GLP-1 RA与基础胰岛素自由剂量联合治疗的2型糖尿病（T2D）患者的治疗持续性及相关结局。
提取2008年7月1日至2013年6月30日期间有≥1次GLP-1 RA和基础胰岛素处方申请的美国成年T2D患者的理赔数据，以及索引日期前6个月（基线）和索引日期后12个月（随访期）的连续健康计划覆盖情况。对按治疗持续性分层的患者分析的结局包括血糖控制、低血糖以及医疗保健成本和资源利用情况。采用多变量分析来检查与持续性或低血糖相关的因素。
分析纳入7320例患者，其中16.9%持续接受自由剂量联合治疗。治疗中断的中位时间为133天。与非持续性患者相比，持续性患者糖化血红蛋白A1c（A1C）降低幅度更大（-0.80%对-0.42%；P=0.032），更有可能使A1C<7.0%（39%对22%；P<0.001），且发生低血糖的可能性更低（9.5%对6.8%；P=0.002）。持续性患者的住院次数也显著更少，住院时间更短。虽然持续性患者的处方费用显著更高（全因：14,691美元对10,791美元；P<0.001；糖尿病相关：8,142美元对5,124美元；P<0.001），但与非持续性患者相比，其总医疗费用显著更低（全因：28,405美元对40,292美元；P=0.001；糖尿病相关：11,114美元对15,203美元；P=0.003）。
这项针对美国T2D患者的回顾性理赔研究表明，尽管同时使用GLP-1 RA和基础胰岛素治疗的持续性较低，但治疗持续性的改善与更大幅度的A1C降低以及更低的总医疗费用相关。
