Schneider John E, Parikh Anjani, Stojanovic Ivana
Avalon Health Economics, Morristown, NJ, USA.
J Health Econ Outcomes Res. 2018 Feb 20;6(1):53-62. doi: 10.36469/9783. eCollection 2018.
Studies have shown that improvements in glycemic control are associated with avoidance or delayed onset of diabetes complications, improvements in health-related quality of life, and reductions in diabetes-related health care costs. Clinical practice guidelines recommend maintaining a hemoglobin A1c (HbA1c) level less than 7%, but among type 2 diabetes patients using insulin, two-thirds have HbA1c above 7% and one-third have HbA1c above 9%.
This study examined the use of insulin management services to enable patients to optimize insulin dosing to achieve HbA1c targets and subsequently reduce health care costs. Cost savings may be achieved through reduced complications and hospitalizations, as well as reduced outpatient, physician, and clinic costs. This study quantified the reduction in pharmaceutical expenses related to the use of an enhanced insulin management service to improve glycemic control.
Two hundred seventeen insulin-reliant patients were enrolled in the d-Nav® Insulin Guidance Service through a participating insurance group. A prospective cost analysis was conducted using data from enrolled patients who completed the first 90 days of follow up.
Of the 192 patients who completed the 90-day study period, 54 (28.13%) were prescribed one or more expensive medications at baseline, but 45 (83.33%) of those patients were eligible for medication discontinuation after 90 days. At baseline, the annual cost of expensive medications per patient was $7564 (CI: $5191-$9938) and $1483 (CI: -$1463-$4429) at 90 days (p<0.001). Direct savings from medication elimination was estimated to be $145 per patient per month (PPPM) or $1736 per patient per year (PPPY) for all patients and $514 PPPM/$6172 PPPY for the target group. Patients that completed the 90-day period significantly reduced HbA1c levels from 9.37% (CI:7.72%-11.03%) at baseline to 7.71% (CI: 6.70%-8.73%) (p<0.001). A total of 170 (88.54%) patients had improved HbA1c at 90 days.
Use of the insulin guidance service achieved improved glycemic control by optimizing insulin dosing, which enabled most patients using the service to reduce or eliminate the use of expensive diabetes medications. Further study is needed to assess the impact of optimized insulin dosing on other diabetes-related health care costs in a usual practice setting.
研究表明，血糖控制的改善与避免或延迟糖尿病并发症的发生、健康相关生活质量的提高以及糖尿病相关医疗费用的降低有关。临床实践指南建议将糖化血红蛋白（HbA1c）水平维持在7%以下，但在使用胰岛素的2型糖尿病患者中，三分之二的患者HbA1c高于7%，三分之一的患者HbA1c高于9%。
本研究探讨使用胰岛素管理服务，使患者能够优化胰岛素剂量以达到HbA1c目标，进而降低医疗费用。可通过减少并发症和住院次数以及降低门诊、医生和诊所费用来实现成本节约。本研究量化了使用强化胰岛素管理服务改善血糖控制后药物费用的减少情况。
通过一个参与的保险集团，217名依赖胰岛素的患者参加了d-Nav®胰岛素指导服务。使用完成前90天随访的登记患者的数据进行前瞻性成本分析。
在完成90天研究期的192名患者中，54名（28.13%）在基线时被开具了一种或多种昂贵药物，但其中45名（83.33%）患者在90天后有资格停药。基线时，每位患者每年昂贵药物的费用为7564美元（CI：5191美元-9938美元），90天时为1483美元（CI：-1463美元-4429美元）（p<0.001）。所有患者因药物停用直接节省的费用估计为每位患者每月145美元（PPPM）或每位患者每年1736美元（PPPY），目标组为514 PPPM/6172 PPPY。完成90天周期的患者HbA1c水平从基线时的9.37%（CI：7.72%-11.03%）显著降至7.71%（CI：6.70%-8.73%）（p<0.001）。共有170名（88.54%）患者在90天时HbA1c有所改善。
使用胰岛素指导服务通过优化胰岛素剂量实现了更好的血糖控制，这使大多数使用该服务的患者减少或停止使用昂贵的糖尿病药物。需要进一步研究以评估在常规实践环境中优化胰岛素剂量对其他糖尿病相关医疗费用的影响。
