title: Comparison of charges and resource use associated with saxagliptin and sitagliptin.
abstract: OBJECTIVE
  Saxagliptin and sitagliptin are two commonly used dipeptidyl peptidase-4 (DPP-4) inhibitors. Little is known about their comparative effectiveness in the real world, particularly their impact on cost and resources use. The objective of this study was to analyze charges and resource use associated with saxagliptin and sitagliptin to understand the impact of these DPP-4 inhibitor treatment options in a real-world setting.
  
  
  METHODS
  This was a retrospective, new-user study approved by the Institutional Review Board at the University of Toledo. Data were collected from a US insurance claims dataset (OptumInsight) for patients newly initiating treatment with saxagliptin or sitagliptin between January 1, 2010 and December 31, 2011. ICD-9 code 250 was used to identify patients with T2D. Overall and diabetes-related medical and pharmacy charges were observed. Inpatient hospitalizations were also compared. Propensity score matching was used to balance the cohorts of patients prescribed saxagliptin and sitagliptin. Appropriate univariate statistical tests were applied to the propensity-matched sample to examine differences in resource utilization outcomes. Statistical significance was evaluated at P < 0.05.
  
  
  RESULTS
  After the propensity score matching, each cohort included 7711 patients. Saxagliptin treatment was associated with lower overall charges ($13,292 vs $14,032; P = 0.0023) and overall medical charges ($9,540 vs $10,296; P = 0.0024) during the 6-month follow-up period compared with sitagliptin treatment. No significant differences were observed in the overall pharmacy charges ($3,751 vs $3,753; P = 0.6937) and the diabetes-related charges ($5,141 vs $5,232; P = 0.2957). All-cause and diabetes-related inpatient hospitalization rates were significantly lower with saxagliptin treatment (p = 0.0001 and p = 0.0019, respectively). All-caused inpatient charges were also significantly lower with saxagliptin ($2,917.26 vs $3445.89; P < 0.0001).
  
  
  CONCLUSIONS
  Compared with patients initiating sitagliptin treatment, patients initiating saxagliptin treatment reported lower overall and medical charges and lower overall and diabetes-related hospitalization rates. These findings may aid payers in managing patients with T2D.
authors.affiliation: Health Outcomes and Socioeconomic Sciences, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Health Science Campus, Mail Stop # 1013, 3000 Arlington Ave., Toledo, OH, 43614, USA. varun.vaidya@utoledo.edu.
authors.forename: Varun
authors.initials: V
authors.lastname: Vaidya
authors.affiliation: Novartis Pharmaceuticals, Hyderabad, India.
authors.forename: Keyuri
authors.initials: K
authors.lastname: Adhikari
authors.affiliation: Health Economics and Outcomes Research, AstraZeneca, Fort Washington, PA, 19034, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Sheehan
authors.affiliation: Health Informatics- Medical Devices, Johnson & Johnson, New York, NY, USA.
authors.forename: Iftekhar
authors.initials: I
authors.lastname: Kalsekar