Poonawalla Insiya B, Abdal Petir, Hayes Mary, John Isha, Diaz Monica, Dixon Suzanne, Bowe Andy
Humana Healthcare Research, Humana Inc., Louisville, KY.
Humana Pharmacy Solutions, Humana Inc., Louisville, KY.
J Manag Care Spec Pharm. 2025 Jul;31(7):627-640. doi: 10.18553/jmcp.2025.31.7.627.
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended as first-line therapy for glycemic management for adults with type 2 diabetes and specific comorbidities. It is unknown whether there are meaningful differences in how GLP-1 RA vs SGLT2i therapy may affect health care resource utilization and medical costs. OBJECTIVE: To compare health care resource utilization and costs in adults with type 2 diabetes newly initiating GLP-1 RA vs SGLT2i therapy. METHODS: We used the Humana Healthcare Research database and a retrospective cohort study design to identify patients with type 2 diabetes, enrolled in a Medicare Advantage Prescription Drug plan from January 1, 2018, to June 30, 2022. Eligible patients had at least 2 pharmacy claims for a GLP-1 RA or SGLT2i drug and had at least 12 months of continuous enrollment prior to and after the first prescription claim. Propensity score matching adjusted for population differences between GLP-1 RA and SGLT2i groups. Subgroup analyses included patients with baseline atherosclerotic cardiovascular disease and obesity. Main outcomes included inpatient stays, emergency department visits, and all-cause health care costs in the 12-month follow-up period. RESULTS: The 1:1 matched cohort consisted of 22,167 individuals each treated with SGLT2i or GLP-1 RA, had a mean age of 68.2 years, and was 52.2% female, 73.4% White, and 18.6% Black. There were no significant differences in all-cause or diabetes-related inpatient stays or emergency department visits between GLP-1 RA and SGLT2i users for overall and subgroup analyses. Compared with SGLT2i patients, those on GLP-1 RA had 3.1% (95% CI = 0.9%-5.3%) higher medical costs in the overall cohort but 2.9% (95% CI = -5.5% to -0.2%) lower medical costs in the obesity subgroup. Pharmacy costs for patients on GLP-1 RA were 6% to 9% higher for overall and subgroup analyses, resulting in 4% to 6% higher total health care costs for GLP-1 RA users relative to SGLT2i users. CONCLUSIONS: There were no significant differences in health care resource utilization in the overall cohort between patients taking GLP-1 RA vs those taking SGLT2i, and pharmacy and total health care costs were higher in the GLP-1 RA group. In the obesity subgroup, GLP-1 RA initiators had lower medical costs.
背景：胰高血糖素样肽-1受体激动剂（GLP-1 RA）或钠-葡萄糖协同转运蛋白-2抑制剂（SGLT2i）被推荐作为患有2型糖尿病及特定合并症的成年人血糖管理的一线治疗药物。目前尚不清楚GLP-1 RA与SGLT2i治疗在影响医疗资源利用和医疗费用方面是否存在显著差异。 目的：比较新开始使用GLP-1 RA与SGLT2i治疗的2型糖尿病成年患者的医疗资源利用和费用。 方法：我们使用了Humana医疗保健研究数据库，并采用回顾性队列研究设计，以识别2018年1月1日至2022年6月30日期间参加医疗保险优势处方药计划的2型糖尿病患者。符合条件的患者至少有2次GLP-1 RA或SGLT2i药物的药房报销记录，且在首次处方报销前后至少连续参保12个月。倾向得分匹配法对GLP-1 RA组和SGLT2i组之间的人群差异进行了调整。亚组分析包括基线患有动脉粥样硬化性心血管疾病和肥胖症的患者。主要结局包括12个月随访期内的住院次数、急诊科就诊次数和全因医疗费用。 结果：1:1匹配队列由22167名分别接受SGLT2i或GLP-1 RA治疗的个体组成，平均年龄为68.2岁，女性占52.2%，白人占73.4%，黑人占18.6%。在总体和亚组分析中，GLP-1 RA使用者和SGLT2i使用者在全因或糖尿病相关住院次数或急诊科就诊次数方面没有显著差异。与SGLT2i患者相比，GLP-1 RA组患者在总体队列中的医疗费用高出3.1%（95%CI = 0.9%-5.3%），但在肥胖亚组中的医疗费用低2.9%（95%CI = -5.5%至-0.2%）。在总体和亚组分析中，GLP-1 RA患者的药房费用高出6%至9%，导致GLP-1 RA使用者的总医疗费用相对于SGLT2i使用者高出4%至6%。 结论：在总体队列中，使用GLP-1 RA的患者与使用SGLT2i的患者在医疗资源利用方面没有显著差异，且GLP-1 RA组的药房费用和总医疗费用更高。在肥胖亚组中，开始使用GLP-1 RA的患者医疗费用较低。
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