Impact of Initiating Insulin Glargine Disposable Pen Versus Vial/Syringe on Real-World Glycemic Outcomes and Persistence Among Patients with Type 2 Diabetes Mellitus in a Large Managed Care Plan: A Claims Database Analysis
Publication: Diabetes Technology & Therapeutics
Volume 16, Issue Number 9
Abstract
Background: Diabetes accounts for almost 15% of all direct healthcare expenditures. Managed care organizations try to reduce costs and improve patient outcomes. Increasing patient persistence with antidiabetes treatment could help achieve these goals.
Subjects and Methods: A retrospective study was conducted using the Optum Research Database (Optum, Eden Prairie, MN) to analyze clinical and economic outcomes associated with initiation of insulin glargine via a disposable pen (GLA-P) or vial and syringe (GLA-V) among adult, insulin-naive patients with type 2 diabetes mellitus (T2DM). Propensity-matched patient cohorts were assessed for persistence with insulin therapy, glycated hemoglobin (A1C), hypoglycemic events (based on diagnosis codes), and healthcare costs (total paid amount of adjudicated claims) after follow-up at 1 year.
Results: In 1,308 matched patients, persistence was significantly higher (P=0.011) and longer (P=0.001) with GLA-P. Follow-up A1C values were significantly lower (P=0.038), and decreases in A1C from baseline significantly larger (P=0.043), in GLA-P than in GLA-V. Significantly fewer hypoglycemic events (P=0.042) were experienced, and a lower rate of diabetes-related inpatient admissions (P=0.008) was reported in GLA-P than GLA-V. Despite higher study drug costs with GLA-P than GLA-V, all-cause and diabetes-related healthcare costs were similar.
Conclusions: In insulin-naive patients with T2DM, initiation of insulin glargine using the disposable pen rather than the vial and syringe is associated with higher persistence, better A1C control, and lower rates of hypoglycemia. The higher study drug costs associated with pen use do not increase total all-cause or diabetes-related healthcare costs. This may help treatment selection for patients with T2DM in a managed care setting.
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Information & Authors
Information
Published In
Diabetes Technology & Therapeutics
Volume 16 • Issue Number 9 • September 2014
Pages: 567 - 575
PubMed: 24735083
Copyright
Copyright 2014, Mary Ann Liebert, Inc.
History
Published in print: September 2014
Published online: 18 August 2014
Published ahead of print: 15 April 2014
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Authors
Author Disclosure Statement
L.X. and O.B. are employees of STATinMED Research, under contract with Sanofi US Inc. S.Z. is an employee of Sanofi US Inc. B.P. was an employee of Optum at the time of this study, and E.B. is a current employee of Optum, under contract with Sanofi US Inc.
L.X. contributed to the development of the study concept, conducted statistical analyses, and co-wrote the study report. S.Z. proposed and co-developed the study concept, co-developed the analysis plan, and interpreted the study data. B.P. is a senior researcher who contributed to the development of the study concept, co-wrote the study report, co-designed the study, and assisted in collecting, analyzing, and interpreting the study data. E.B. is a senior researcher who contributed to the development of the study concept, co-designed the study, and assisted in collecting, analyzing, and interpreting the study data. O.B. co-developed the statistical analysis plan, provided input for the study report, advised on data cleaning, and assisted in interpreting the data. All authors have provided input during manuscript development, have reviewed the manuscript, and have approved the final version prior to submission.
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