title: Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.
abstract: BACKGROUND
  The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes.
  
  
  METHODS
  An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted.
  
  
  RESULTS
  Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada.
  
  
  CONCLUSIONS
  Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.
authors.affiliation: Institut Universitaire de Gériatrie de Montréal, Quebec, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Boulin
authors.affiliation: College of Pharmacy and Pharmaceutical Sciences, Florida A&M University (FAMU), Tallahassee, Florida, United States of America.
authors.forename: Vakaramoko
authors.initials: V
authors.lastname: Diaby
authors.affiliation: Institut Universitaire de Gériatrie de Montréal, Quebec, Canada.|Université de Montréal, Faculties of Medicine and Pharmacy, Quebec, Canada.
authors.forename: Cara
authors.initials: C
authors.lastname: Tannenbaum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000191:economics* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D008687:Metformin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D018803:Models, Economic; D009010:Monte Carlo Method; D017063:Outcome Assessment, Health Care / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D008687:Metformin