Eli Lilly and Company, Indianapolis, Indiana.
HealthMetrics Outcomes Research, Bonita Springs, Florida.
J Manag Care Spec Pharm. 2020 Sep;26(9):1081-1089. doi: 10.18553/jmcp.2020.26.9.1081.
Research has shown that many patients with type 2 diabetes (T2D) are not adherent to their medication regimen.
To examine the association between adherence to insulin therapy and all-cause health care costs for patients with T2D.
This study used the IQVIA PharMetrics Plus Linkable to Ambulatory Electronic Medical Record data from January 1, 2012, through September 30, 2017. Patients were included if they were identified with T2D and initiated therapy on basal insulin (BAS) or basal-bolus (BAS-BOL) combination at any time from January 1, 2013, through October 1, 2016. Patients aged < 18 years, who used an insulin pump, identified as pregnant, or did not have continuous insurance coverage from 1 year before initiation on insulin therapy through 1 year after initiation were excluded. Descriptive statistics compared patient characteristics and costs (in U.S. 2017 dollars) between patients who were adherent or nonadherent to their insulin therapy in the 1-year postperiod, where adherence was defined as having proportion of days covered (PDC) of at least 80%. In addition, generalized linear models were used to compare costs between adherent and nonadherent patients, while controlling for patient characteristics, previous general health and comorbidities, resource utilization, medication use and type of insulin.
13,296 patients were included in the BAS cohort (5,502 adherent; 7,794 nonadherent) and 10,069 in the BAS-BOL cohort (2,006 adherent; 8,063 nonadherent). Adherent patients had significantly lower all-cause total unadjusted costs following initiation on BAS ($29,322 vs. $31,888, = 0.0134) and BAS-BOL combination ($36,229 vs. $40,147, = 0.0078). Drug costs comprised 39.5%-45.4% of costs among adherent patients and 23.0%-25.9% of costs among nonadherent patients. Multivariable analyses revealed that adherent patients had significantly lower adjusted all-cause total costs than nonadherent patients in the BAS cohort ($30,127 vs. $37,049, 95% CI for difference -$8,460 to -$5,384) and the BAS-BOL cohort ($36,603 vs. $44,702, 95% CI for difference -$9,129 to -$6,980).
In patients with T2D who initiated BAS or BAS-BOL combination therapy, adherence was associated with significantly lower all-cause total health care costs, despite significantly higher drug costs. These results illustrate the potential economic benefits associated with adherence to insulin therapy. DISCLOSURES": Eli Lilly and Company funded this study and was responsible for study design and execution. Bajpai, Eby, Faries, and Haynes are employees and own stock in Eli Lilly and Company. Lage received compensation from Eli Lilly and Company for her work on this research project.
研究表明，许多 2 型糖尿病（T2D）患者不遵守其药物治疗方案。
研究胰岛素治疗依从性与 T2D 患者全因医疗保健费用之间的关系。
本研究使用了 IQVIA PharMetrics Plus 与门诊电子病历数据的链接，时间范围为 2012 年 1 月 1 日至 2017 年 9 月 30 日。如果患者在 2013 年 1 月 1 日至 2016 年 10 月 1 日期间任何时候开始使用基础胰岛素（BAS）或基础-餐时（BAS-BOL）联合治疗，则符合纳入标准。排除年龄<18 岁、使用胰岛素泵、被诊断为怀孕或在胰岛素治疗开始前 1 年至开始后 1 年内没有连续保险覆盖的患者。描述性统计比较了在治疗后 1 年内依从性或不依从性胰岛素治疗的患者的特征和成本（以 2017 年美元计算），其中依从性定义为有至少 80%的比例天数覆盖（PDC）。此外，使用广义线性模型比较了依从性和不依从性患者的成本，同时控制了患者特征、既往一般健康和合并症、资源利用、药物使用和胰岛素类型。
共纳入 13296 名 BAS 队列患者（5502 名依从性患者；7794 名不依从性患者）和 10069 名 BAS-BOL 队列患者（2006 名依从性患者；8063 名不依从性患者）。与起始使用 BAS 时相比，依从性患者的全因总未经调整成本显著降低（$29322 与 $31888， = 0.0134）和起始使用 BAS-BOL 联合治疗时（$36229 与 $40147， = 0.0078）。药物成本占依从性患者成本的 39.5%-45.4%，占不依从性患者成本的 23.0%-25.9%。多变量分析显示，与不依从性患者相比，依从性患者在 BAS 队列（$30127 与 $37049，95%CI 差值为$-8460 至$-5384）和 BAS-BOL 队列（$36603 与 $44702，95%CI 差值为$-9129 至$-6980）的全因总成本明显较低。
在起始使用 BAS 或 BAS-BOL 联合治疗的 T2D 患者中，尽管药物成本明显较高，但依从性与全因总医疗保健成本显著降低相关。这些结果说明了与胰岛素治疗依从性相关的潜在经济效益。
礼来公司资助了这项研究，并负责研究设计和执行。Bajpai、Eby、Faries 和 Haynes 是礼来公司的员工，拥有该公司的股票。Lage 因参与该研究项目而从礼来公司获得报酬。
