Budgetary Impact of Thiazolidinedione (TZD) Add-On Therapy Relative to Insulin (INS) Add-On Therapy in Individuals Treated with Sulfonylureas (SU): A Third Party Payer's Perspective.

Balu, Sanjeev; Arondekar, Bhakti; Lee, Won Chan; Horblyuk, Ruslan; Pashos, Chris L.

This study evaluated the economic impact to a managed care organization's budget of adding a TZD versus INS to SU monotherapy for the management of type 2 diabetes (T2D). Using an integrated medical and pharmacy claims database from 07/01 to 06/02, we identified T2D patients treated with SU monotherapy, who subsequently received a TZD or INS in addition to SU monotherapy. Per-member per-month (PMPM) total healthcare costs and pharmacy (Rx) costs during two-years of follow-up were assessed. 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 994 individuals (Mean [SD]: 53.4 [10.4] years; 51.0% males) were identified, with 384 initiating INS add-on and 610 initiating TZD add-on to SU monotherapy. There were no significant differences in age or gender across the two groups, however, INS add-on patients had greater cardiovascular comorbidities and other complications. Although overall PMPM Rx costs were lower for the TZD add-on group ($262 [$3,739] vs. $360 [$4,026], p<0.01), diabetes-related Rx costs were greater for TZD-add on group ($109.4 [$3,336] vs. $96.1 [$2,067]; P=0.04). Despite higher PMPM diabetes-related Rx costs, patients with TZD-add on therapy realized cost savings of $96 PMPM over two years as compared to patients with INS ($229 [$6,448.] vs. $325 [$9,159]; p=0.01). After adjusting for differences in baseline characteristics, patients with INS add-on therapy incurred 22% (p<0.05) higher total health care costs compared to patients on TZD add-on therapy. The findings from this study demonstrate that the addition of TZD to SU monotherapy was associated with a significant 22% reduction in PMPM total health care costs versus add-on therapy with INS.

HYPOGLYCEMIC agents; INSULIN therapy; HYPOGLYCEMIC sulfonylureas; TYPE 2 diabetes; MANAGED care programs; MEDICAL care costs

Diabetes, 2007, Vol 56, pA653

0012-1797

Academic Journal