Gao Yue, Wang Ke, Chen Yun, Shen Li, Hou Jianing, Xuan Jianwei, Liu Bao
Shanghai Centennial Scientific Co. Ltd, Shanghai, China.
Lilly Suzhou Pharmaceutical Co., Ltd, Suzhou, China.
Diabetes Ther. 2018 Apr;9(2):673-682. doi: 10.1007/s13300-018-0382-8. Epub 2018 Feb 23.
To assess and compare per-day anti-diabetic medication costs for Chinese type-2 diabetes mellitus (T2DM) insulin-naïve patients between those who initiated premixed insulin analogs ("premixed group") and those who initiated long-acting insulin analogs ("long-acting group").
Data were obtained from an electronic medical record database between 2010.01.01 and 2015.06.30 covering medical encounter records from all general hospitals in a district from Shanghai, China. Insulin-naïve T2DM patients who were aged ≥ 18 years, treated with an oral anti-diabetic drug (OAD) only during the baseline period (3 months prior to insulin initiation), and initiated premixed or long-acting insulin analogs were included. Patients were followed until index insulin discontinuation or 12 months after initiation, whichever came first. The t test and generalized linear models adjusting for propensity score (PS) (including baseline demographics, number of OAD classes, comorbidities, costs, and healthcare resource utilization) were used to examine the differences between the two insulin groups.
A total of 570 and 185 patients were identified for the premixed and long-acting groups, with mean (SD) ages of 63.0 (12.8) and 61.1 (11.9) (P = 0.08) and male proportions of 47.4% and 51.4% (P = 0.35), respectively. During the baseline period, 19.3% of the premixed users had T2DM-related hospitalizations, while the rate was 12.4% in the long-acting group (P = 0.03). The mean number of T2DM-related outpatient visits was 0.98 and 1.23 for the premixed and long-acting groups, respectively (P = 0.07). During the follow-up period, the per-day insulin dose averaged 31.7 and 15.3 international units (IU) for the premixed and long-acting groups, respectively. Compared with the patients on premixed insulin, the mean per-day cost for patients on long-acting insulin was 37.3% higher [15.3 vs 11.2 Chinese yuan (RMB); mean difference (MD) (95% CI): 4.2 (3.2, 5.1)] for the overall anti-diabetes medication, 81.3% higher [3.3 vs 1.8 RMB; MD (95% CI): 1.5 (0.8, 2.2)] for OAD, and 28.6% higher [12.0 vs 9.3 RMB; MD (95% CI): 2.7 (2.1, 3.3)] for insulin. The results were consistent after adjusting for the PS.
Among Chinese T2DM insulin-naïve patients, those who initiated premixed insulin had a lower per-day antidiabetic medication cost than those who initiated long-acting insulin.
Lilly Suzhou Pharmaceutical Co. Ltd, China.
评估并比较中国2型糖尿病（T2DM）初治患者中，起始使用预混胰岛素类似物的患者（“预混组”）与起始使用长效胰岛素类似物的患者（“长效组”）的每日抗糖尿病药物费用。
数据来自2010年1月1日至2015年6月30日的电子病历数据库，涵盖中国上海某区所有综合医院的医疗记录。纳入年龄≥18岁、仅在基线期（起始胰岛素前3个月）接受口服抗糖尿病药物（OAD）治疗且起始使用预混或长效胰岛素类似物的T2DM初治患者。对患者进行随访，直至索引胰岛素停用或起始后12个月，以先到者为准。采用t检验和倾向得分（PS）调整的广义线性模型（包括基线人口统计学、OAD类别数量、合并症、费用和医疗资源利用情况）来检验两组胰岛素治疗患者之间的差异。
预混组和长效组分别确定了570例和185例患者，平均（标准差）年龄分别为63.0（12.8）岁和61.1（11.9）岁（P = 0.08），男性比例分别为47.4%和51.4%（P = 0.35）。在基线期，19.3%的预混胰岛素使用者有T2DM相关住院治疗，而长效组的这一比例为12.4%（P = 0.03）。预混组和长效组T2DM相关门诊就诊的平均次数分别为0.98次和1.23次（P = 0.07）。在随访期内，预混组和长效组的每日胰岛素剂量平均分别为31.7国际单位（IU）和15.3国际单位（IU）。与预混胰岛素治疗的患者相比，长效胰岛素治疗患者的总体抗糖尿病药物每日平均费用高37.3%[15.3元对11.2元人民币（RMB）；平均差值（MD）（95%CI）：4.2（3.2，5.1）]，OAD费用高81.3%[3.3元对1.8元RMB；MD（95%CI）：1.5（0.8，2.2）]，胰岛素费用高28.6%[12.0元对9.3元RMB；MD（95%CI）：2.7（2.1，3.3）]。调整PS后结果一致。
在中国T2DM初治患者中，起始使用预混胰岛素的患者每日抗糖尿病药物费用低于起始使用长效胰岛素的患者。
中国礼来苏州制药有限公司。
