Guideline-conformity of initiation with oral hypoglycemic treatment for patients with newly therapy-dependent type 2 diabetes mellitus in Austria.

PURPOSE: To determine guideline conformity of initiation of oral hypoglycemic (OH) treatment for type 2 diabetes in Austria; to study patient and prescriber correlates of recommended initiation with metformin monotherapy. METHODS: We used claims from 11 sickness funds that covered 7.5 million individuals, representing >90% of the Austrian population. First-time OH use was defined as a first filled prescription after one year without any OH drug or insulin. Among these incident users, we described the OH drug class used and defined correlates of initiation with metformin monotherapy. RESULTS: From 1/2007 to 6/2008, we identified 42,882 incident users of an OH drug: 70.8% used metformin, 24.7% used a sulfonylurea, and 4.5% initiated treatment with another class. We estimated the incidence of OH-dependent type 2 diabetes at 3.8-4.4 per 1000 patient-years. We conducted multivariate analyses among 39 077 patients with available prescriber information. Independent correlates of initiation with metformin were younger age, female gender, waived co-payment, more recent initiation, fewer hospital days and more therapeutic classes received in the year prior to first OH therapy (all p < 0.001). Prescriber specialty and age (p < 0.001), but not gender, were also associated with metformin initiation. Approximately 20% of metformin initiators had a second OH drug added within <18 months. While we were unable to ascertain specific contraindications to metformin (renal insufficiency, hepatic failure), <10% of the general population are expected to have these conditions. CONCLUSIONS: Seventy per cent of new initiators of OH treatment in Austria received metformin as recommended by international guidelines. At least 20% did not, taking into account possible contraindications, which provides an opportunity for intervention.

Impact of reimbursement changes on statin use among patients with diabetes in Austria.

BACKGROUND: Statins have evolved as cornerstones of cardiovascular prevention in patients with diabetes. They are effective and can be cost-effective therapies, but increased use imposes a sizeable short-term burden on payors of health care. These have used various instruments to steer appropriate use of such treatment. It was the purpose of this study to examine the effect of two reimbursement policy changes of statin therapy in patients with diabetes in Austria. METHODS: Retrospective cohort study; time-series analysis. From Austrian sickness funds claims, we identified a closed cohort of 68,953 patients receiving treatment for diabetes in the first quarter of 2004. From April 2004 - December 2005, we ascertained use of statins for each monthly interval. Patients were censored at death. We used pseudo-experimental time-series regression to evaluate the effect of two policy changes on statin use and cost overall, as well as on the use of preferred versus non-preferred statins. RESULTS: Statin use among Austrian patients with diabetes increased from 20.6% to 24.9% during the time period. A policy change essentially expanding reimbursement for statins from secondary to primary prevention among patients with diabetes had no discernible effect on the observed trends in statin use. Another policy change that imposed random chart review for appropriateness of prescription of non-preferred statins including atorvastatin 10 mg yielded a marked drop in use of atorvastatin 10 mg and increase in the use of preferred statins, while leaving overall trends in statin use unaffected. CONCLUSIONS: Quantitative evaluation of new policies can provide important insights into the effectiveness und utility of such changes.