title: Healthcare Costs Among Adults with Type 2 Diabetes Initiating DPP-4 Inhibitors.
abstract: BACKGROUND
  Oral antidiabetes medications, including dipeptidyl peptidase-4 inhibitors (DPP-4is) saxagliptin and sitagliptin, are used for the treatment of type 2 diabetes (T2D). The study objective was to compare all-cause and diabetes-related costs following initiation of saxagliptin or sitagliptin.
  
  
  METHODS
  Patients aged ≥ 18 years initiating saxagliptin or sitagliptin between January 1, 2009 and January 31, 2012 in the Truven Health MarketScan Commercial and Medicare Supplemental databases were identified. Patients were required to have continuous enrollment for ≥ 365 days before and ≥ 365 days after the index date (date of the first saxagliptin or sitagliptin claim). Additionally, patients were required to have a claim with a T2D diagnosis (ICD-9-CM 250.×0, 250.×2) and no claims for a DPP-4i medication before the index date. All-cause and diabetes-related medical costs and total costs (including pharmacy costs) were captured over the 1-year follow-up period. Generalized linear models with log link and gamma distribution were fit to compare costs between the two cohorts using cost ratios, controlling for patient baseline characteristics. Recycled prediction methods were used to generate adjusted predicted costs and confidence intervals.
  
  
  RESULTS
  The final sample comprised 3354 saxagliptin initiators and 26,895 sitagliptin initiators. The average age of saxagliptin and sitagliptin initiators was 57 years and just over 50% were males. After adjusting for baseline characteristics, saxagliptin patients had significantly lower average all-cause medical costs (cost ratio = 0.901, P < 0.001; predicted mean costs: $8687 vs. $9646) compared with sitagliptin patients over the 1-year follow-up. Findings were consistent for diabetes-related medical costs (cost ratio = 0.890, P < 0.001; predicted mean costs: $2180 vs. $2450). Total costs were also lower for saxagliptin initiators (cost ratio = 0.950, P = 0.002; predicted mean costs: $13,911 vs. $14,651) over the 1-year follow-up period.
  
  
  CONCLUSIONS
  Initiation of treatment with saxagliptin was associated with lower medical costs over 1 year compared with initiation of sitagliptin among adults with T2D.
  
  
  BACKGROUND
  AstraZeneca.
authors.affiliation: Truven Health Analytics, Cambridge, MA, USA. amanda.farr@truvenhealth.com.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Farr
authors.affiliation: AstraZeneca, Fort Washington, PA, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Sheehan
authors.affiliation: Truven Health Analytics, Cambridge, MA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Brouillette
authors.affiliation: Truven Health Analytics, Cambridge, MA, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Smith
authors.affiliation: Truven Health Analytics, Cambridge, MA, USA.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Johnston
authors.affiliation: Johnson & Johnson, New Brunswick, NJ, USA.
authors.forename: Iftekhar
authors.initials: I
authors.lastname: Kalsekar
mesh_terms: D000218:Adamantane / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004151:Dipeptides / Q000191:economics / Q000627:therapeutic use; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000068900:Sitagliptin Phosphate / Q000191:economics / Q000627:therapeutic use; D014481:United States
chemical_list: D004151:Dipeptides; D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; C502994:saxagliptin; D000218:Adamantane; D000068900:Sitagliptin Phosphate
keywords: Dipeptidyl peptidase-4 inhibitors; Healthcare costs; Saxagliptin; Sitagliptin; Type 2 diabetes mellitus