Healthcare costs and adherence associated with human regular U-500 versus high-dose U-100 insulin in patients with diabetes.
OBJECTIVE
Describe the characteristics, costs, and adherence of patients receiving human regular U-500 insulin (U-500R) compared with those of patients receiving high-dose (≥150 units/day) U-100 insulin.


METHODS
Data from Truven Health MarketScan Research Databases, July 1, 2008, through December 31, 2010, were used. The U-100 cohort received ≥150 units/day of U-100 insulin for ≥31 days during the first 60 days after the index date. The U-500R cohort received ≥2 prescriptions of U-500R after the index date. Analyses were performed on propensity-matched cohorts. The changes in annualized costs were compared between the 2 cohorts using paired t tests. Adherence was assessed by the proportion of days covered (PDC) and compared using a 2-sample t test. Glycemic efficacy data were not available in this database.


RESULTS
There were 1,044 U-500R-treated patients (19.1% with type 1 diabetes [T1D]) and 11,520 U-100-treated patients (23.8% with T1D) identified, from which 1,039 matched pairs were obtained. The mean decrease of $1,290 in annual pharmacy costs for the U-500R cohort was significantly different from the mean increase of $2,586 for the U-100 cohort (P<.001; 95% confidence interval, -$4,345 to -$3,422). More U-500R patients experienced hypoglycemia (17.3% vs. 11.8%; P<.001), but the hypoglycemia rate per person and related costs were not significantly different between cohorts. Finally, the mean 12-month PDC was 65.0% for U-500R versus 47.6% for U-100 patients (P<.0001).


CONCLUSIONS
Compared with treatment with ≥150 units/day of U-100 insulin, treatment with U-500R was associated with decreases in pharmacy costs, a higher percentage of patients experiencing hypoglycemia, and greater treatment adherence.
Eli Lilly and Company, Indianapolis, Indiana.
Elizabeth L
EL
Eby
Eli Lilly and Company, Indianapolis, Indiana.
Anthony J
AJ
Zagar
Eli Lilly and Company, Indianapolis, Indiana Biogen Idec, Weston, Massachusetts.
Ping
P
Wang
Eli Lilly and Company, Indianapolis, Indiana.
Bradley H
BH
Curtis
Eli Lilly and Company, Indianapolis, Indiana.
Jin
J
Xie
Eli Lilly and Company, Indianapolis, Indiana.
Diane C
DC
Haldane
School of Graduate Entry Medicine, University of Nottingham, Nottingham, United Kingdom.
Iskandar
I
Idris
Keck School of Medicine, University of Southern California, Los Angeles, California.
Anne L
AL
Peters
Endocrine Clinic of Southeast Texas, Beaumont, Texas.
Robert C
RC
Hood
Lilly USA, LLC, Indianapolis, Indiana.
Jeffrey A
JA
Jackson
D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies
D007328:Insulin