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- Title
Economic Analysis of Add--on Therapy with Thiazolidinedione (TZD) versus Insulin (INS) to Metformin (MET) Monotherapy.
- Authors
Balu, Sanjeev; Arondekar, Bhakti; Lee, Won Chan; Horblyuk, Ruslan; Pashos, Chris L.
- Abstract
Changes to pharmacotherapy for type 2 diabetes (T2D) are generally based on stability of glycemic control and therapy tolerability. Differences in glycemic control often influence resource utilization which in-turn impacts health care costs. This study assessed the economic impact of addition of a TZD vs. INS to T2D patients receiving monotherapy with MET. Administrative claims data from a large integrated medical and pharmacy claims database were used. T2D adults on MET monotherapy who received add-on therapy with TZD or INS were identified based on pharmacy claims from 07/2001 through 06/2002. Primary endpoints included differences in baseline comorbidities and unadjusted two-year follow-up total cost. Multivariate generalized linear models were used to assess the cost differential of TZD add-on versus INS add-on accounting for differences in baseline demographics, comorbidities, and pre-index health care costs. A total of 1,608 individuals were identified with 1,153 receiving add-on therapy with TZD versus 455 receiving INS add-on therapy. Although there were no significant differences in age or gender between TZD (mean=51.4 years, 46.4% males) and INS (mean=51.5 years, 47.9% males) add-on cohorts, patients with TZD-add on had decreased prevalence of cardiovascular disease (15.4% vs. 19.6%; p< 0.01 ) and increased prevalence of hypertension (45% vs. 39.3%; p=0.04) at baseline. The unadjusted two-year follow-up total costs were significantly lower among TZD users as compared to INS users ($17,339.80 vs. $21,150.30; P=0.03). This difference persisted after adjusting for differences in baseline characteristics, with patients on INS+MET incurring 20% (p<0.05) higher total health care costs compared to patients on TZD+MET. Controlling for differences in comorbidities, this analysis showed significant reduction in costs with TZD vs. INS as add-on therapy to MET monotherapy. These differences indicate that selection of a TZD as the second agent can have an important economic impact on healthcare costs for T2D.
- Subjects
HYPOGLYCEMIC agents; INSULIN therapy; MEDICAL care costs; MEDICAL economics; TREATMENT of diabetes
- Publication
Diabetes, 2007, Vol 56, pA653
- ISSN
0012-1797
- Publication type
Article