title: Utilization and costs of glucose lowering therapies following health technology assessment for the new reimbursement scheme in Sweden.
abstract: OBJECTIVE
  A new reimbursement scheme (RS) for glucose lowering therapies (GLT) was implemented in Sweden on March 1, 2010. Products on the market were retained, restricted, excluded or excluded for new courses in the new RS. The aim of this study was to compare utilization and costs of GLT for type 2 diabetes Mellitus (T2DM) before and after the implementation of the changed RS.
  
  
  METHODS
  This was a quasi-experimental study using data on dispensed GLT and costs from a database on dispensed individual based prescriptions in Sweden. Segmented regression analyses were used to assess utilization and costs.
  
  
  RESULTS
  Following the changed reimbursement status, there was an accelerated increasing trend in number of patients treated with restricted (P=0.0007) or retained (P=0.0021) insulins, as well as in costs for insulin based GLT (P=0.0014). No impact was detected in the total number of patients treated with oral GLT, but a slightly negative trend in total costs for oral GLT was detected following the intervention (P=0.0177).
  
  
  CONCLUSIONS
  The new reimbursement scheme had a minor impact on utilization and costs of oral GLT. Despite restricted reimbursement for patients with T2DM, the utilization of insulin based GLT and related costs increased faster following the intervention.
authors.affiliation: The Center for Medical Technology Assessment, CMT Linköping University, 581 83 Linköping, Sweden. Billie_pettersson@merck.com
authors.forename: Billie
authors.initials: B
authors.lastname: Pettersson
authors.forename: Mikael
authors.initials: M
authors.lastname: Hoffmann
authors.forename: David
authors.initials: D
authors.lastname: Andersson
authors.forename: Per
authors.initials: P
authors.lastname: Wändell
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Levin
mesh_terms: D000284:Administration, Oral; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D016527:Drug Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D013548:Sweden; D013673:Technology Assessment, Biomedical
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin