title: Use of healthcare resources and costs associated to the start of treatment with injectable drugs in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  The main objective was to assess resource use and costs of starting treatment with insulin or injectable GLP-1 receptor analogues (GLP-1 RAs) in a Spanish population of patients with type 2 diabetes mellitus. Treatment adherence and persistence were also determined for both treatment groups.
  
  
  METHODS
  A retrospective, non-interventional, observational study was conducted. Patients aged ≥20 years who started treatment with insulin or GLP-1 RAs in the 2010-2012 period were recruited. Use of healthcare resources was estimated to evaluate healthcare costs in these two groups of patients (medical visits, hospital stay, emergency visits, diagnostic or treatment requests, medication). Clinical information including body mass index (BMI, kg/m2), metabolic control (HbA1c), adherence, persistence, and complications (hypoglycemia, and cardiovascular events (CVE) was collected. The follow-up period was 12 months. Only direct healthcare costs were considered.
  
  
  RESULTS
  A total of 1301 patients with a mean age of 67.6 years (51.6% males) were recruited. Of these, 71.9% and 28.1% were on treatment with insulin and GLP-1 RA respectively. After one year of follow-up, patients treated with GLP-1 RAs were found less visits to primary care (8 vs. 11; P<.001) and specialized care (1.0 vs. 1.8; P<.001), hospital stays (0.3 vs. 0.7; P=.030) and less visits to the emergency room (0.8 vs. 1.6; P<.001). Patients treated with GLP-1 showed greater adherence (88.1% vs. 82.7%; P<.001) and persistence (62.0% vs. 55.9%; P=.046), and had less hypoglycemia episodes (13.4% vs. 18.7%; P=.022), with similar metabolic control (HbA1c: 7.2% vs. 7.4%; P=.049), BMI (29.1 vs. 30.9kg/m2), and CVE rate (9.1% vs. 11.5%; P=.330) respectively. The mean corrected direct healthcare cost per patient was €1787 vs. €2005 (P=.046.) CONCLUSIONS: Patients treated with GLP-1 RAs caused lower direct healthcare costs for the National Health System than patients treated with insulin. The results may be explained by greater treatment adherence and lower hypoglycemia rates in patients treated with GLP-1 RAs. Additional studies are needed to confirm these possibilities.
authors.affiliation: Dirección de Planificación, Badalona Serveis Assistencials SA, Badalona, Barcelona, España.
authors.forename: Antoni
authors.initials: A
authors.lastname: Sicras-Mainar
authors.affiliation: Documentación Médica, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: Ruth
authors.initials: R
authors.lastname: Navarro-Artieda
authors.affiliation: Departamento de Evaluación de Medicamentos, GlaxoSmithKline, Madrid, España. Electronic address: raul.l.morano-larragueta@gsk.com.
authors.forename: Raúl
authors.initials: R
authors.lastname: Morano
authors.affiliation: Departamento de Evaluación de Medicamentos, GlaxoSmithKline, Madrid, España.
authors.forename: Lucía
authors.initials: L
authors.lastname: Ruíz
mesh_terms: D000368:Aged; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D004363:Drug Utilization / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007267:Injections; D007328:Insulin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
keywords: Adherence; Adherencia; Consumo de recursos sanitarios; Costes sanitarios; Diabetes tipo 2; Healthcare costs; Healthcare resource utilization; Hipoglucemias; Hypoglycemia; Persistence; Persistencia; Type 2 diabetes