title: Healthcare resource utilization and related financial costs associated with glucose lowering with either exenatide or basal insulin: A retrospective cohort study.
abstract: Type 2 diabetes is a major health problem placing increasing demands on healthcare systems. Our objective was to estimate healthcare resource use and related financial costs following treatment with exenatide-based regimens prescribed as once-weekly (EQW) or twice-daily (EBID) formulations, compared with regimens based on basal insulin (BI).
  
  
  
  This retrospective cohort study used data from the UK Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES). Patients with type 2 diabetes who received exenatide or BI between 2009 and 2014 as their first recorded exposure to injectable therapy were selected. Costs were attributed to primary care contacts, diabetes-related prescriptions and inpatient admissions using standard UK healthcare costing methods (2014 prices). Frequency and costs were compared between cohorts before and after matching by propensity score using Poisson regression.
  
  
  
  Groups of 8723, 218 and 2180 patients receiving BI, EQW and EBID, respectively, were identified; 188 and 1486 patients receiving EQW and EBID, respectively, were matched 1:1 to patients receiving BI by propensity score. Among unmatched cohorts, total crude mean costs per patient-year were £2765 for EQW, £2549 for EBID and £4080 for BI. Compared with BI, the adjusted annual cost ratio (aACR) was 0.92 (95% CI, 0.91-0.92) for EQW and 0.82 (95% CI, 0.82-0.82) for EBID. Corresponding costs for the propensity-matched subgroups were £2646 vs £3283 (aACR, 0.80, 0.80-0.81) for EQW vs BI and £2532 vs £3070 (aACR, 0.84, 0.84-0.84) for EBID vs BI.
  
  
  
  Overall, exenatide once-weekly and twice-daily-based regimens were associated with reduced healthcare resource use and costs compared with basal-insulin-based regimens.
authors.affiliation: Pharmatelligence, Cardiff, UK.
authors.forename: Sarah E
authors.identifier: 0000-0002-4315-5681
authors.initials: SE
authors.lastname: Holden
authors.affiliation: Pharmatelligence, Cardiff, UK.
authors.forename: Christopher Ll
authors.identifier: 0000-0001-8796-7406
authors.initials: CL
authors.lastname: Morgan
authors.affiliation: AstraZeneca, Gothenburg, Sweden.
authors.forename: Qing
authors.initials: Q
authors.lastname: Qiao
authors.affiliation: Pharmatelligence, Cardiff, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Jenkins-Jones
authors.affiliation: Pharmatelligence, Cardiff, UK.
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Berni
authors.affiliation: Pharmatelligence, Cardiff, UK.|School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Currie
mesh_terms: D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000191:economics; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D004334:Drug Administration Schedule; D016527:Drug Costs; D000077270:Exenatide; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010455:Peptides / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D011320:Primary Health Care / Q000191:economics; D012189:Retrospective Studies; D063127:Secondary Health Care / Q000191:economics; D013222:State Medicine; D006113:United Kingdom; D014688:Venoms / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D010455:Peptides; D014688:Venoms; D000077270:Exenatide
keywords: database research; exenatide; insulin therapy; observational study; type 2 diabetes