title: Comparison of costs among patients with type 2 diabetes treated with exenatide or sitagliptin therapy.
abstract: BACKGROUND
  Exenatide (Byetta, Amylin Pharmaceuticals Inc., CA, USA) and sitagliptin (Januvia, Merck & Co, NJ, USA) are two antidiabetic agents recently approved by the US Food and Drug Administration. The purpose of this analysis was to compare costs among patients with type 2 diabetes (T2D) treated with either of these agents.
  
  
  METHODS
  Data with dates of service from September 1, 2005 through August 31, 2007, were obtained from a large US retrospective claims database. Intent-to-treat cohorts of adults diagnosed with T2D who began taking either exenatide (n=1885) or sitagliptin (n=2482) and did not use the alternate medication in the 6-month follow-up period were created. Six-month total medical costs were estimated using stepwise multivariate regressions. Six-month total diabetes-related medical costs, a component of total medical costs, were also estimated using stepwise multivariate regressions. In addition, other cost components were examined using either stepwise multivariate regressions or a two-part model that controlled for the probability of using the medical service. Smearing estimates were used to transform estimated log costs into costs. The analysis controlled for the potential impact of patient demographics, general health, prior resource use, comorbidities, and timing of treatment initiation.
  
  
  RESULTS
  Exenatide was associated with lower total 6-month direct medical costs ($9340 vs. $9995; P<0.0001), despite some component costs being slightly higher with exenatide: diabetes-related drug costs ($1765 vs. $1743; P=0.0062), diabetes-related medical costs ($4142 vs. $4002; P<0.0001), and emergency room costs ($43 vs. $29; P=0.0388). Exenatide was associated with lower outpatient costs ($4498 vs. $5942; P<0.0001).
  
  
  CONCLUSIONS
  Compared with the use of sitagliptin, exenatide was associated with lower total medical costs (difference of $655) despite higher total diabetes-related costs (difference of $140). As a result, there appears to be overall cost savings associated with the use of exenatide relative to sitagliptin.
authors.affiliation: HealthMetrics Outcomes Research LLC, 120 Anchorage Circle, Groton, Connecticut 06340, USA. lagemj@hlthmetrics.com
authors.forename: Maureen J
authors.initials: MJ
authors.lastname: Lage
authors.forename: Rosalind
authors.initials: R
authors.lastname: Fabunmi
authors.forename: Kristina S
authors.initials: KS
authors.lastname: Boye
authors.forename: Derek A
authors.initials: DA
authors.lastname: Misurski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics; D017046:Cost Savings; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics / Q000378:metabolism; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D016527:Drug Costs / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics; D000077270:Exenatide; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010455:Peptides / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D011719:Pyrazines / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D012044:Regression Analysis; D012189:Retrospective Studies; D000068900:Sitagliptin Phosphate; D014230:Triazoles / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D014481:United States; D014688:Venoms / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D000077270:Exenatide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D010455:Peptides; D011719:Pyrazines; D000068900:Sitagliptin Phosphate; D014230:Triazoles; D014688:Venoms