Perez-Nieves Magaly, Boye Kristina S, Kiljanski Jacek, Cao Dachung, Lage Maureen J
Eli Lilly and Company, Indianapolis, IN, USA.
HealthMetrics Outcomes Research, LLC, Bonita Springs, FL, USA.
Diabetes Ther. 2018 Jun;9(3):1099-1111. doi: 10.1007/s13300-018-0421-5. Epub 2018 Apr 11.
This research compares costs, resource utilization, and complications between adherent and nonadherent patients over the 3-year period post initiation on basal insulin therapy.
The study utilized the US-based Truven Health MarketScan Research Databases from 2011 through 2015. Adults aged 18 years or older and identified with type 2 diabetes (T2D) who initiated therapy on basal insulin in 2012 were included. Patients were excluded if they were pregnant, filled their index basal insulin prescription via mail order, or were not continuously insured from 1 year before through 3 years following initiation of treatment with basal insulin. Instrumental variables were used to control for selection bias, and multivariable analyses were used to examine the associations between adherence to basal insulin therapy and costs, resource utilization, and acute complications.
A total of 21,363 individuals were included in the study. Three years after initiating therapy on basal insulin, patients who were adherent over time to basal insulin treatment therapy (33.8% of patients) had significantly higher diabetes-related drug costs. However, patients' adherence was associated with significantly lower diabetes-related outpatient, acute care, and total costs. Results for all-cause costs were similar. Adherent patients also had significantly fewer all-cause and diabetes-related hospitalizations and emergency room visits and were significantly less likely to be diagnosed with an acute complication.
Results of this study illustrate that despite higher drug costs, there are disease-specific and all-cause cost offsets and improved patient outcomes associated with adherence to basal insulin therapy for people with T2D.
Eli Lilly and Company.
本研究比较了基础胰岛素治疗开始后3年期间依从性和非依从性患者的成本、资源利用情况及并发症。
该研究使用了美国2011年至2015年的Truven Health MarketScan研究数据库。纳入2012年开始基础胰岛素治疗、年龄在18岁及以上且确诊为2型糖尿病（T2D）的成年人。如果患者怀孕、通过邮购方式开具基础胰岛素初始处方，或在基础胰岛素治疗开始前1年至治疗后3年期间未持续参保，则将其排除。使用工具变量控制选择偏倚，并采用多变量分析来检验基础胰岛素治疗依从性与成本、资源利用及急性并发症之间的关联。
共有21363人纳入研究。开始基础胰岛素治疗3年后，长期坚持基础胰岛素治疗的患者（占患者总数的33.8%）糖尿病相关药物成本显著更高。然而，患者的依从性与糖尿病相关门诊、急症护理及总成本显著降低相关。全因成本结果相似。依从性患者的全因和糖尿病相关住院及急诊就诊次数也显著更少，被诊断为急性并发症的可能性也显著更低。
本研究结果表明，尽管药物成本较高，但对于T2D患者，坚持基础胰岛素治疗可带来疾病特异性和全因成本抵消，并改善患者预后。
礼来公司。
