title: Effect of Combination Cholesterol-Lowering Therapy and Triglyceride-Lowering Therapy on Medical Costs in Patients With Type 2 Diabetes Mellitus.
abstract: High triglyceride (TG) levels among patients with type 2 diabetes mellitus (DM) are associated with higher medical costs. We analyzed the economic impact of TG-lowering therapies and whether the association between medical costs and therapy differed according to TG reduction. We conducted an observational cohort study of 184,932 patients with diabetes mellitus who had a TG measurement between January 2012 and June 2013 and a second TG measurement 3 to 15 months later. We identified 4 therapy groups (statin monotherapy, TG-specific monotherapy, statin/TG-specific combination therapy, or no therapy) and stratified those groups by percent change in TG (increased ≥5%, change of ≤4.9%, decreased 5% to 29%, decreased ≥30%). We compared change in medical costs between the year before and after therapy, adjusted for demographic and clinical characteristics. Of the 184,932 total patients, 143,549 (77.6%) received statin monotherapy, 900 (0.5%) received TG-specific monotherapy, 1,956 (1.1%) received statin and TG-specific combination therapy, and 38,527 (20.8%) received no prescription lipid agents. After covariate adjustment, statin/TG-specific agent recipients had a mean 1-year total cost reduction of $1,110. The greatest cost reduction was seen among statin/TG-specific combination therapy patients who reduced TG levels by ≥30% (-$2,859). Statin monotherapy patients who reduced TG by ≥30% also had a large reduction in adjusted costs (-$1,079). In conclusion, we found a substantial economic benefit to treating diabetic patients with statin/TG-specific combination lipid therapy compared with monotherapy of either type or no lipid pharmacotherapy. A TG reduction of ≥30% produced a particularly large reduction in 1-year medical costs.
authors.affiliation: Kaiser Permanente Center for Health Research, Science Programs Department, Portland, Oregon. Electronic address: greg.nichols@kpchr.org.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
authors.affiliation: Kaiser Permanente Southern California, Department of Research and Development, Pasadena, California.
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
authors.affiliation: AstraZeneca LP, Health Economics and Outcomes Research, Wilmington, Delaware.
authors.forename: Temitope
authors.initials: T
authors.lastname: Olufade
authors.affiliation: Kaiser Permanente Center for Health Research, Science Programs Department, Portland, Oregon.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Kimes
authors.affiliation: Kaiser Permanente Center for Health Research, Science Programs Department, Portland, Oregon.
authors.forename: Maureen
authors.initials: M
authors.lastname: O'Keeffe-Rosetti
authors.affiliation: Kaiser Permanente Center for Health Research, Science Programs Department, Portland, Oregon.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Sapp
authors.affiliation: AstraZeneca LP, Health Economics and Outcomes Research, Wilmington, Delaware.
authors.forename: Deborah
authors.initials: D
authors.lastname: Anzalone
authors.affiliation: Kaiser Permanente Center for Health Research, Science Programs Department, Portland, Oregon.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Fortmann
mesh_terms: D000368:Aged; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000191:economics; D004359:Drug Therapy, Combination; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005260:Female; D058607:Fibric Acids / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D015228:Hypertriglyceridemia / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000627:therapeutic use; D012189:Retrospective Studies; D014280:Triglycerides / Q000097:blood
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D015525:Fatty Acids, Omega-3; D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D014280:Triglycerides; D009525:Niacin