Greater persistence and adherence to basal insulin therapy is associated with lower healthcare utilization and medical costs in patients with type 2 diabetes: a retrospective database analysis

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM BMJ Open Diabetes Research & Care Pub Date : 2024-03-01 DOI:10.1136/bmjdrc-2023-003825
Vanita R Aroda, Nick Nielsen, Kamal K Mangla, Jasjit Multani, Victoria Divino, Tarlan Namvar, Jigar Rajpura
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Abstract

Introduction We aimed to assess persistence and adherence to basal insulin therapy, their association with all-cause healthcare resource utilization (HCRU) and direct medical costs, and predictors of persistence and adherence in adults with type 2 diabetes. Research design and methods A retrospective cohort study was conducted with US adults with type 2 diabetes initiating basal insulin therapy between January 1, 2016, and December 31, 2018, using IQVIA PharMetrics Plus claims data. Persistence and adherence were assessed during 1 year post-initiation per previous definitions. Demographic/clinical characteristics were assessed during the 1 year pre-initiation. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding variables. Post-IPTW, all-cause HCRU and direct medical costs were assessed during the first-year and second-year post-initiation by persistence and adherence status. Multivariable logistic regression was used to identify predictors of persistence and adherence. Results The final sample comprised 64,953 patients; 56.8% demonstrated persistence and 41.9% demonstrated adherence. Patients demonstrating persistence and adherence were significantly less likely to have a hospitalization than patients demonstrating non-persistence or non-adherence, respectively. In the second-year post-initiation, total mean all-cause direct medical costs per patient were lower for patients demonstrating persistence and significantly lower for patients demonstrating adherence. Prior use of both oral and injectable antidiabetic medication predicted persistence and adherence compared with patients with only prior oral antidiabetic medication use (persistence OR, 1.50 (95% CI, 1.44 to 1.57); adherence OR, 1.48 (95% CI, 1.42 to 1.55)). Conclusions Persistence and adherence to basal insulin was associated with fewer hospitalizations and lower direct medical costs. Data are available upon reasonable request. The underlying data sets used in this study are available with permission from IQVIA, but restrictions apply to the availability of these data, which were used under license for the current study and therefore are not publicly available.
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基础胰岛素治疗的持续性和依从性越高,2 型糖尿病患者的医疗利用率和医疗费用就越低:一项回顾性数据库分析
导言 我们旨在评估基础胰岛素治疗的持续性和依从性、它们与全因医疗资源利用率(HCRU)和直接医疗成本的关联,以及2型糖尿病成人患者持续性和依从性的预测因素。研究设计与方法 使用 IQVIA PharMetrics Plus 索赔数据,对 2016 年 1 月 1 日至 2018 年 12 月 31 日期间开始基础胰岛素治疗的美国成人 2 型糖尿病患者进行了一项回顾性队列研究。根据之前的定义,对启动后一年内的持续性和依从性进行了评估。人口统计学/临床特征在启动前 1 年进行评估。采用反向治疗概率加权法(IPTW)调整混杂变量。IPTW后,按持续性和依从性状况评估了启动后第一年和第二年的全因HCRU和直接医疗费用。多变量逻辑回归用于确定持续性和依从性的预测因素。结果 最终样本包括 64953 名患者;56.8% 的患者表现为坚持治疗,41.9% 的患者表现为坚持治疗。表现出坚持和依从性的患者住院的几率分别明显低于表现出不坚持或不依从性的患者。在开始治疗后的第二年,坚持治疗的患者人均全因直接医疗总费用较低,而坚持治疗的患者人均全因直接医疗总费用明显较低。与之前只使用过口服抗糖尿病药物的患者相比,之前同时使用过口服和注射抗糖尿病药物的患者更容易坚持和依从治疗(坚持OR,1.50(95% CI,1.44-1.57);依从OR,1.48(95% CI,1.42-1.55))。结论 坚持使用基础胰岛素可减少住院次数和直接医疗费用。如有合理要求,可提供相关数据。本研究中使用的基础数据集由 IQVIA 许可提供,但这些数据的提供受到限制,因为这些数据是在许可下用于本研究的,因此不能公开提供。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
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