title: Comparison of vials and prefilled pens of a rapid-acting insulin analog on pharmacy budgets in a long-term care setting.
abstract: OBJECTIVE
  Estimate budgetary impact for skilled nursing facility converting from individual patient supply (IPS) delivery of rapid-acting insulin analog (RAIA) 10-mL vials or 3-mL prefilled pens to 3-mL vials.
  
  
  METHODS
  A budget-impact model used insulin volume purchased and assumptions of length of stay (LOS), daily RAIA dose, and delivery protocol to estimate the cost impact of using 3-mL vials.
  
  
  METHODS
  Skilled nursing facility.
  
  
  METHODS
  Medicare Part A patients.
  
  
  METHODS
  Simulations conducted using 12-month current and future scenarios. Comparisons of RAIA use for 13- and 28-day LOS.
  
  
  METHODS
  RAIA costs and savings, waste reduction.
  
  
  RESULTS
  For patients with 13-day LOS using 20 units/day of IPS insulin, the model estimated a 70% reduction in RAIA costs and units purchased and a 95% waste reduction for the 3-mL vial compared with the 10-mL vial. The estimated costs for prefilled pen use were 58% lower than for use of 10-mL vials. The incremental savings associated with 3-mL vial use instead of prefilled pens was 28%, attributable to differences in per-unit cost of insulin in vials versus prefilled pens. Using a more conservative scenario of 28-day LOS at 20 units/day, the model estimated a 40% reduction in RAIA costs and units purchased, resulting in a 91% reduction in RAIA waste for the 3-mL vial, compared with 10-mL vial.
  
  
  CONCLUSIONS
  Budget-impact analysis of conversion from RAIA 10-mL vials or 3-mL prefilled pens to 3-mL vials estimated reductions in both insulin costs and waste across multiple scenarios of varying LOS and patient daily doses for skilled nursing facility stays.
authors.affiliation: Economics and Health Policy, Medtronic, Inc., Minneapolis, Minnesota, USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Eby
authors.forename: Lee J
authors.initials: LJ
authors.lastname: Smolen
authors.forename: Amber C
authors.initials: AC
authors.lastname: Pitts
authors.forename: Linda A
authors.initials: LA
authors.lastname: Krueger
authors.forename: Jeffrey Scott
authors.initials: JS
authors.lastname: Andrews
mesh_terms: D000368:Aged; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D007328:Insulin / Q000191:economics / Q000627:therapeutic use; D061266:Insulin, Short-Acting / Q000191:economics / Q000627:therapeutic use; D008134:Long-Term Care; D008297:Male; D010593:Pharmaceutical Services; D010604:Pharmacy; D012189:Retrospective Studies; D013594:Syringes
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D061266:Insulin, Short-Acting