title: The association between use of mealtime insulin pens versus vials and healthcare charges and resource utilization in patients with type 2 diabetes: a retrospective cohort study.
abstract: OBJECTIVE
  To compare all-cause and diabetes-related resource utilization and healthcare charges among adults with type 2 diabetes mellitus who initiated therapy with mealtime insulin disposable pens or vials.
  
  
  METHODS
  Data were obtained from the Innovus inVision database from January 1, 2006 through June 30, 2010. Generalized linear models with a gamma distribution and log link estimated the association between medical charges and use of mealtime insulin pens vs vials in the 1 year post-index date, while generalized linear models with a negative binomial distribution estimated resource utilization.
  
  
  RESULTS
  Controlling for patient characteristics, general health, and patient copayments, insulin therapy initiation with disposable pens, compared to vials, was associated with significantly fewer all-cause hospitalizations (1.45 vs. 1.66; p < 0.0001) as well as a significantly shorter hospital length of stay (2.16 days vs. 3.53 days; p < 0.0001). Pen use, compared to vials, was also associated with significantly fewer diabetes-related hospitalizations (1.36 vs. 1.47; p < 0.0001), and shorter hospital length of stay (1.12 days vs. 1.72 days; p < 0.0001). Despite higher diabetes-related drug charges ($3593 vs. $2755; p < 0.0001) associated with the use of pens, results showed significantly lower all-cause total healthcare charges ($42,150 vs. $53,340; p < 0.0001) and significantly lower diabetes-related total healthcare charges ($12,722 vs. $14,540; p < 0.0001) for patients who initiated therapy on mealtime insulin with pens compared to vials.
  
  
  CONCLUSIONS
  Data were drawn from administrative claims and included only patients with medical and outpatient prescription drug benefit coverage. Hence, the results may not be generalizable. The retrospective analyses relied on diagnostic codes to identify patients, assess patient general health, and determine other values, rather than formal, clinical assessments. The analyses did not include indirect healthcare costs.
  
  
  CONCLUSIONS
  The administration of mealtime insulin via disposable pens, compared to vials, was associated with a significant reduction in all-cause and diabetes-related resource utilization and total healthcare charges.
authors.affiliation: Global Health Outcomes, Eli Lilly and Company , Indianapolis, IN , USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Eby
authors.forename: Kristina S
authors.initials: KS
authors.lastname: Boye
authors.forename: Maureen J
authors.initials: MJ
authors.lastname: Lage
mesh_terms: D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics*; D004209:Disposable Equipment / Q000191:economics; D016503:Drug Delivery Systems / Q000191:economics*; D005249:Fees and Charges; D005260:Female; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D062407:Meals; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin