Tang Yuexin, Huang Xingyue, Liu Jinan, Shankar R Ravi, Ganz Michael L, Rajpathak Swapnil
Associate Director, MRL, Merck & Co, Inc., Kenilworth, NJ.
Director, MRL, Merck & Co, Inc., Kenilworth, NJ, during this study.
Am Health Drug Benefits. 2017 Dec;10(9):456-462.
Health plans have responded to the many treatment options for type 2 diabetes mellitus by implementing formulary restriction policies, including step therapy, to control costs. Little is known about the impact of step therapy programs on antidiabetes medication use.
To assess the impact of a sitagliptin step therapy program on antidiabetes medication use among sitagliptin users.
Using pharmacy claims from the Symphony Health Solutions' Integrated Dataverse, we compared the use of sitagliptin and other antidiabetes medications by patients enrolled in a health plan (Plan A) that implemented a sitagliptin step therapy program on July 1, 2013, with the use by patients who were contemporaneously enrolled in 2 comparison plans-Plans B and C-without step therapy programs. Sitagliptin-a dipeptidyl peptidase (DPP)-4 inhibitor-was in tier 3 in Plans A and B and in tier 2 in Plan C during the study period. We assessed the use of antidiabetes medications during the pre-step therapy period (January-June 2013) and the post-step therapy period (October 2013-March 2014).
We identified 2995 patients enrolled in Plan A, 751 enrolled in Plan B, and 394 enrolled in Plan C who received sitagliptin during the pre-step therapy period. Patient characteristics and pre-step therapy sitagliptin use were similar across plans. During the post-step therapy period, more patients in Plan A (approximately 70%) discontinued sitagliptin than patients in Plan B (approximately 51%) and Plan C (approximately 25%). Approximately 30% of patients in Plan A switched to another DPP-4 inhibitor compared with approximately 15% and 2% of patients in Plans B and C, respectively. Seventeen percent of patients in Plan A discontinued sitagliptin without replacement but continued using other antidiabetes medications compared with approximately 13% and 8% of patients in Plans B and C, respectively. In all, 17% of patients in Plans A and B and 11% of patients in Plan C discontinued using all antidiabetes medications.
The step therapy program changed patients' use of sitagliptin, which was the target of the step therapy program, as well as of other antidiabetes medications. Most patients stopped sitagliptin treatment after the step therapy program started. Some patients discontinued sitagliptin treatment without replacement, but others discontinued using all antidiabetes medications.
健康计划通过实施包括阶梯治疗在内的处方集限制政策来应对2型糖尿病的多种治疗选择，以控制成本。关于阶梯治疗方案对抗糖尿病药物使用的影响知之甚少。
评估西格列汀阶梯治疗方案对西格列汀使用者抗糖尿病药物使用的影响。
利用Symphony Health Solutions综合数据集的药房报销数据，我们比较了2013年7月1日实施西格列汀阶梯治疗方案的健康计划（计划A）中患者使用西格列汀和其他抗糖尿病药物的情况，与同期参加2个对照计划（计划B和计划C）且无阶梯治疗方案的患者的使用情况。在研究期间，西格列汀（一种二肽基肽酶-4抑制剂）在计划A和计划B中属于第3层，在计划C中属于第2层。我们评估了阶梯治疗前时期（2013年1月至6月）和阶梯治疗后时期（2013年10月至2014年3月）抗糖尿病药物的使用情况。
我们确定在阶梯治疗前时期接受西格列汀治疗的患者中，计划A有2995例，计划B有751例，计划C有394例。各计划间患者特征和阶梯治疗前西格列汀使用情况相似。在阶梯治疗后时期，计划A中停用西格列汀的患者（约70%）比计划B（约51%）和计划C（约25%）中的患者更多。计划A中约30%的患者换用了另一种二肽基肽酶-4抑制剂，而计划B和计划C中分别约为15%和2%。计划A中17%的患者停用西格列汀且未更换药物，但继续使用其他抗糖尿病药物，而计划B和计划C中分别约为13%和8%。总体而言，计划A和计划B中17%的患者以及计划C中11%的患者停用了所有抗糖尿病药物。
阶梯治疗方案改变了患者对作为阶梯治疗方案目标药物的西格列汀以及其他抗糖尿病药物的使用。阶梯治疗方案开始后，大多数患者停止了西格列汀治疗。一些患者停用西格列汀且未更换药物，但另一些患者停用了所有抗糖尿病药物。
