Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Sistemas de Liberação de Medicamentos/psicologia , Insulina/administração & dosagem , Marketing/economia , Preferência do Paciente/psicologia , Administração por Inalação , Diabetes Mellitus Tipo 1/economia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/psicologia , Aprovação de Drogas , Sistemas de Liberação de Medicamentos/economia , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/economia , Injeções Subcutâneas/economia , Injeções Subcutâneas/psicologia , Insulina/economia , Avaliação das Necessidades , Preferência do Paciente/economia , Estados Unidos , United States Food and Drug AdministrationRESUMO
OBJECTIVE: The study was designed to evaluate real-world data on clinical and economic outcome differences between patients with type 2 diabetes mellitus (T2DM) who use insulin glargine with vial-and-syringe delivery and those who switch to pen administration. SUBJECTS AND METHODS: This retrospective study analyzed medical and pharmacy claims information from the national managed-care IMPACT(®) database (Ingenix Inc., Salt Lake City, UT). Adults with T2DM treated with insulin glargine were evaluated. Clinical and economic outcomes over 1 year were compared between individuals who had converted from administering glargine via vial-and-syringe to the SoloSTAR(®) (sanofi-aventis U.S., Bridgewater, NJ) pen (Switchers) and patients who continued to use vial-and-syringe administration (Continuers). Patients from each cohort were matched using propensity score matching for a comparison sample. RESULTS: In total, 3,893 eligible patients were identified (665 Switchers and 3,228 Continuers), with a matched cohort with 603 patients in each group. Baseline characteristics were similar between groups. One-year treatment persistence was significantly higher with Switchers versus Continuers (65.3% vs. 49.8%; P<0.0001). Medication possession ratio was also significantly higher among Switchers (0.79 vs. 0.76; P=0.0173). Insulin use and glycemic control were similar between groups. Healthcare utilization and total costs were also similar between groups. Higher prescription costs among Switchers were offset by lower overall and diabetes-related outpatient and inpatient costs. CONCLUSIONS: Switching from insulin glargine vial-and-syringe administration to pen delivery resulted in improved treatment adherence and persistence, with comparable clinical and economic outcomes.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Sistemas de Liberação de Medicamentos , Hipoglicemiantes/administração & dosagem , Insulina de Ação Prolongada/administração & dosagem , Ansiedade , Diabetes Mellitus Tipo 2/psicologia , Equipamentos Descartáveis , Sistemas de Liberação de Medicamentos/psicologia , Cálculos da Dosagem de Medicamento , Desenho de Equipamento , Feminino , Custos de Cuidados de Saúde , Humanos , Injeções Subcutâneas/efeitos adversos , Injeções Subcutâneas/psicologia , Insulina Glargina , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Dor/etiologia , Dor/psicologia , Preferência do Paciente/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Seringas/efeitos adversosRESUMO
Duet® is a microbicide-delivery system and cervical barrier for use daily or precoitally. We conducted a crossover study among 80 Zimbabwean women to explore factors associated with use-regimen preference. Women were assigned in random order to 14 days of precoital and 14 days of daily Duet and BufferGel use. About 51 % of women preferred precoital use, 39 % preferred daily use, and 10 % liked both equally. Overall product adherence during sex was similar for both use-regimens. In multivariable analysis, diaphragm experience was associated with preference for precoital use (AOR 2.80, 95 % CI 1.01-7.76). Reasons for preferring precoital use included use only when needed, cleanliness, and discomfort with daily use. Daily use preference included convenience, discreetness, and being prepared for "sex-on-demand." Different personal and life circumstances may result in varying use-regimen preferences. Methods that can accommodate both coitally-related and daily use may be advantageous by providing more choice to users.