University Hospital Llandough, Penarth, Cardiff, UK.
Novo Nordisk Service Centre India Pvt Ltd, Bangalore, India.
Diabetes Obes Metab. 2022 Jul;24(7):1300-1309. doi: 10.1111/dom.14703. Epub 2022 May 3.
To investigate the budget implications of treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) versus other glucose-lowering treatment (here termed 'standard of care' [SoC]) during 2012-2019.
GLP-1 RA-naïve adults with type 2 diabetes (T2D) in the IBM MarketScan database with at least one glucose-lowering medication claim within 6 months after their first cardiovascular disease (CVD) hospitalization were included (index date was the date of first claim for a GLP-1 RA for the GLP-1 RA group, and the date of the first claim, independent of medication type, for the SoC group). Monthly healthcare costs and hospitalization risk over 12 months postindex date were compared for those who initiated a GLP-1 RA posthospitalization versus those with a claim for any other glucose-lowering medication.
Postindex date, mean observed total costs were lower for patients receiving a GLP-1 RA compared with SoC ($3853 vs. $4288). In adjusted analysis, both groups had similar total healthcare costs (P = .56). This was driven by significantly lower inpatient and outpatient costs and higher drug costs in the GLP-1 RA group compared with SoC (P < .001). Risks of all-cause (adjusted hazard ratio: 0.85) and CVD-related hospitalization (0.76) were significantly lower in the GLP-1 RA group compared with SoC (P < .001). Similar results were observed in a subgroup with atherosclerotic CVD.
These findings suggest that, in US patients with T2D and a CVD-related hospitalization, the added medical cost of treatment with GLP-1 RAs is offset by lower inpatient and outpatient care costs, resulting in budget neutrality against SoC.
调查 2012 年至 2019 年期间,使用胰高血糖素样肽-1 受体激动剂(GLP-1 RAs)与其他降血糖治疗(以下称为“标准护理”[SoC])相比的治疗预算影响。
在 IBM MarketScan 数据库中,纳入 GLP-1 RA 初治的 2 型糖尿病(T2D)成年人,他们在首次心血管疾病(CVD)住院后 6 个月内至少有一次降血糖药物索赔(索引日期是 GLP-1 RA 组首次索赔 GLP-1 RA 的日期,SoC 组是首次索赔的日期,与药物类型无关)。比较那些在出院后开始使用 GLP-1 RA 与那些使用任何其他降血糖药物索赔的患者在索引日期后 12 个月内的每月医疗保健费用和住院风险。
与 SoC 相比,接受 GLP-1 RA 治疗的患者在索引日期后,观察到的总费用明显较低(3853 美元对 4288 美元)。在调整分析中,两组的总医疗保健费用相似(P = 0.56)。这是由于 GLP-1 RA 组的住院和门诊费用显著降低,而药物费用显著增加,与 SoC 相比(P<0.001)。与 SoC 相比,GLP-1 RA 组的全因(调整后的危险比:0.85)和 CVD 相关住院(0.76)风险显著降低(P<0.001)。在有动脉粥样硬化性 CVD 的亚组中观察到了类似的结果。
这些发现表明,在美国患有 T2D 和 CVD 相关住院的患者中,使用 GLP-1 RAs 的额外医疗费用被降低的住院和门诊护理费用所抵消,与 SoC 相比预算保持平衡。