Medstat MercuryMD Micromedex PDR Solucient THOMSON HEALTHCARE DIFFERENCES IN HEALTHCARE UTILIZATION...

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THOMSON HEALTHCARE

DIFFERENCES IN HEALTHCARE UTILIZATION

AND EXPENDITURES AMONG TYPE 2

DIABETES MEDICARE PATIENTS INITIATING

ANALOG AND HUMAN INSULINS Margolis JM1, Chu BC1, Johnson B1, Forma F2, Alemayehu B3

1Thomson Healthcare, Ann Arbor, MI, USA2Novo Nordisk, Princeton, NJ, USA3Novo Nordisk, Princeton, NJ, USA (at time of study)

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©2007 Thomson Healthcare. All rights reserved.Medstat • MercuryMD • Micromedex • PDR • Solucient

Study Rationale

• Increases in glycemic control have been found with adjunctive insulin therapy in type 2 diabetes (T2D)

• Trends show use of adjunctive insulin therapy in T2D has been growing in the US.

• Researchers have been investigating whether these findings varied by type of insulin therapy used.

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Study Objective

• To compare the differences in direct healthcare utilization and expenditures among Medicare recipients with T2D initiating analog insulin versus human insulin.

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Methods

• Patient selection

Total Medicare 2001-2006N = 3,887,712

≥2 insulin Rxs in 180 days+ Diabetes diagnosisn = 140,840 (3.6%) Enrolled 12 mos. pre & post

Medical & Rx benefitn = 66,946 (47%)

Type 2 diabetes onlyn = 17,171 (98%)

Insulin naïve preindexn = 17,521 (26%)

Analog onlyn = 8,991 (52%)

Human onlyn = 5,015 (29%)

Bothn = 3,165 (19%)

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Methods• Data source

– 2001–2006 MarketScan® Medicare Supplemental and Coordination of Benefits Database (Thomson Healthcare)

• Healthcare utilization and expenditures– Dependent variables included total, inpatient, ER, outpatient, and Rx

– All-cause and diabetes-related

– Compared treatment groups for pre-index and post-index periods.

• Generalized multi-valued propensity score weighting– To control for observable differences in distributions of pretreatment

variables among treatment groups.

• Effects of covariates were modeled with generalized linear models.

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Descriptive Results

Table 1. Patient Demographic and Clinical Characteristics

*Newly treated patients were defined as having no pharmacy claim for any antihyperglycemic medication during the 12-month pre-index period.

Analog Insulin Human Insulin P-value

Number of patients 8,991 5,015

% Female 44.5 49.5 <0.001

Mean age (SD) 73.2 (6.4) 74.7 (6.8) <0.001

% Newly treated* 8.5 25.6 <0.001

% Insurance Type

Indemnity

HMO

POS

PPO

Other

69.9

9.0

2.3

18.2

0.6

58.7

17.7

4.0

19.1

0.5

<0.001

<0.001

<0.001

<0.001

<0.001

Mean Deyo-Charlson Comorbidity Index Score (SD)

2.50 (1.92) 2.78 (2.10) <0.001

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Descriptive Results

Table 1. Patient Demographic and Clinical Characteristics

*Newly treated patients were defined as having no pharmacy claim for any antihyperglycemic medication during the 12-month pre-index period.

Analog Insulin Human Insulin P-value

Number of patients 8,991 5,015

% Female 44.5% 49.5% <0.001

Mean age (SD) 73.2 (6.4) 74.7 (6.8) <0.001

% Newly treated* 8.5% 25.6% <0.001

% Insurance Type

Indemnity

HMO

POS

PPO

Other

69.9%

9.0%

2.3%

18.2%

0.6%

58.7%

17.7%

4.0%

19.1%

0.4%

<0.001

<0.001

<0.001

<0.001

<0.001

Mean Deyo-Charlson Comorbidity Index Score (SD)

2.50 (1.92) 2.78 (2.10) <0.001

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Descriptive Results

Table 2. Unadjusted Mean Healthcare Utilization over 12-month Follow-up Period

Analog Insulin Human Insulin

Mean S.D. Mean S.D. p-value

Inpatient visits 0.50 1.13 0.58 1.66 <0.001

Length of stay (days) 5.04 10.34 6.44 18.00 <0.001

Emergency visits 0.79 2.50 0.93 3.25 0.004

Office visits 10.59 11.79 9.07 17.09 <0.001

Clinic visits 0.41 2.80 0.45 3.85 0.562

Other O/P claims 43.18 63.58 47.52 99.32 0.002

• Analog insulin patients had overall lower all-cause healthcare utilization in the follow-up period, except for office visits.

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Descriptive Results

Table 3. Unadjusted Mean Expenditures over 12-Month Follow-up Period


Mean S.D. Mean S.D. P-value

Total costs $17,002 $33,309 $18,747 $54,221 0.019

Total diabetes-related $3,909 $10,187 $3,482 $16,096 0.055

Inpatient visits $3,805 $16,738 $5,069 $34,159 0.003

Inpatient diabetes-related $970 $7,704 $1,305 $14,307 0.072

Emergency visits $162 $1,159 $184 $1,598 0.354

Office visits $703 $1,105 $592 $1,159 <0.001

Clinic visits $23 $165 $26 $248 0.307

Other O/P services claims $6,630 $24,198 $8,109 $32,579 0.002

Index Rx $629 $722 $327 $1,137 <0.001

Other Diabetes-related Rx $1,130 $1,442 $707 $1,603 <0.001

All non-index Rx $5,213 $5,837 $4,624 $7,834 <0.001

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Descriptive Results• Inpatient visits, length of stay, and ER visits were significantly lower for

analog insulin patients, however the number of office visits was significantly higher for analog patients.

• Analog insulin patients had significantly lower total all-cause costs in the postindex period.

• Postindex diabetes-related costs were higher for analog patients, possibly attributable to the higher drug-related expenditures.

• Inpatient costs as well as other outpatient services were lower for analog patients. Office visit costs were higher for analog patients.

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Multivariable Analysis• Multivariable analysis of the postindex costs was performed to control

for effects of patient age, gender, geographic region, treatment onset (newly treated vs. continuing), insurance type, and preindex comorbidity (Deyo-Charlson comorbidity index scores).

• Focused on total costs, inpatient costs, and prescription costs (all-cause and diabetes-related)

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Multivariable Analysis

Figure 1. Adjusted Mean Total Healthcare Costs for 12-Month Follow-Up PeriodAdjusted Mean Total Costs for Analog vs. Human Insulin

$16,345

$3,778$3,259

$16,328

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

Adjusted Mean Total Healthcare Costs (p=0.969)

Diabetes-related costs (p<0.001)

Ave

rag

e C

ost


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Multivariable Analysis

Figure 2. Adjusted Mean Inpatient Costs and Rx Costs for the 12-Month Follow-Up Period Adjusted Average Costs by Healthcare Category for Analog vs. Human Insulin

$3,372

$705

$5,677

$1,700

$4,207

$945

$4,753

$1,050

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

Inpatient costs (p=0.003)

Diabetes-related Inpatient costs

(p=0.028)

Rx costs (p<0.001)

Diabetes-related Rx costs (p<0.001)

Ave

rag

e C

ost


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Multivariable Analysis• Post-treatment all-cause total costs were not significantly different

between analog and human subjects, however post-treatment diabetes-related costs were lower for human insulin patients.

• Analog patients had significantly lower inpatient costs, both all-cause and diabetes-related, while having significantly higher prescription costs (both all-cause and diabetes-related) compared to human insulin patients, consistent with descriptive results.

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Discussion• Patients with T2D using adjunctive insulin showed different baseline

characteristics depending on whether they were started on analog insulin or on human insulin.

– Treatment groups’ differences at baseline could be contributing to differences seen during analysis of the post-treatment outcomes metrics.

• Health care resource utilization was generally lower for analog patients, except for office visits.

• After controlling for covariates, total all-cause healthcare costs were not found to be significantly different between these treatment groups.

• Inpatient costs, both all-cause and diabetes-related, were lower for analog patients.

• Prescription and office visit costs were higher for analog patients.

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Discussion

• Questions & comments

Thank you !!

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