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1.
Value Health ; 24(2): 227-235, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33518029

RESUMEN

OBJECTIVES: This study aims to estimate the national impact and cost-effectiveness of the 2018 American College of Physicians (ACP) guidance statements compared to the status quo. METHODS: Survey data from the 2011-2016 National Health and Nutrition Examination were used to generate a national representative sample of individuals with diagnosed type 2 diabetes in the United States. Individuals with A1c <6.5% on antidiabetic medications are recommended to deintensify their A1c level to 7.0% to 8.0% (group 1); individuals with A1c 6.5% to 8.0% and a life expectancy of <10 years are recommended to deintensify their A1c level >8.0% (group 2); and individuals with A1c >8.0% and a life expectancy of >10 years are recommended to intensify their A1c level to 7.0% to 8.0% (group 3). We used a Markov-based simulation model to evaluate the lifetime cost-effectiveness of following the ACP recommended A1c level. RESULTS: 14.41 million (58.1%) persons with diagnosed type 2 diabetes would be affected by the new guidance statements. Treatment deintensification would lead to a saving of $363 600 per quality-adjusted life-year (QALY) lost for group 1 and a saving of $118 300 per QALY lost for group 2. Intensifying treatment for group 3 would lead to an additional cost of $44 600 per QALY gain. Nationally, the implementation of the guidance would add 3.2 million life-years and 1.1 million QALYs and reduce healthcare costs by $47.7 billion compared to the status quo. CONCLUSIONS: Implementing the new ACP guidance statements would affect a large number of persons with type 2 diabetes nationally. The new guidance is cost-effective.


Asunto(s)
Diabetes Mellitus Tipo 2/sangre , Sociedades Médicas/normas , Adulto , Anciano , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/economía , Hemoglobina A Glucada , Guías como Asunto , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Humanos , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Esperanza de Vida , Persona de Mediana Edad , Modelos Económicos , Estados Unidos
4.
Expert Rev Pharmacoecon Outcomes Res ; 21(2): 221-233, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33317348

RESUMEN

Introduction: As a novel glucagon-like peptide-1receptor agonist (GLP-1 RA) for type 2 diabetes (T2D) treatment, the economic value of once-weekly semaglutide had been assessed in several country settings. The authors' objective was to systematically review the existing pharmacoeconomic literature evaluating the cost-effectiveness associated with once-weekly semaglutide compared with other GLP-1 RAs and provide implications for further researches.Areas covered: We conducted a systematic literature review of cost-effectiveness analysis (CEA) published up to 25 July 2020 in PubMed, web of science, and the ISPOR presentation database, compared once-weekly semaglutide with other GLP-1 RAs in T2D. Nineteen studies were identified, including 8 short-term and 11 long-term studies. General characteristics and main results of the included studies were summarized.Expert opinion: This review provided references for other countries to overview the value of once-weekly semaglutide compared with other GLP-1 RAs in T2D in the healthcare decision-making process and to conduct their CEA studies associated with once-weekly semaglutide. The authors found that the cardiovascular (CV) benefit of once-weekly semaglutide was under-estimated in current studies and suggested that the methods of economic evaluations for novel anti-diabetic drugs with CV benefit should be improved in future researches.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Péptidos Similares al Glucagón/administración & dosificación , Hipoglucemiantes/administración & dosificación , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/economía , Esquema de Medicación , Economía Farmacéutica , Receptor del Péptido 1 Similar al Glucagón/agonistas , Péptidos Similares al Glucagón/economía , Péptidos Similares al Glucagón/farmacología , Humanos , Hipoglucemiantes/economía , Hipoglucemiantes/farmacología
5.
Nihon Koshu Eisei Zasshi ; 67(8): 501-508, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-32879236

RESUMEN

Objectives Medical expenses for diabetes differ between Japan's 47 prefectures. The medical care expenditure regulation plan aims to reduce regional differences in outpatient medical costs through prevention of severe diabetes, promotion of specific health checkups and specific health guidance, promotion of generic drugs, and proper use of medicines. To achieve this goal, we need to conduct an in-depth analysis of inter-prefecture differences in diabetes care expenses. This study analyzed regional differences in prescription fees for dipeptidyl peptidase-4 (DPP-4) inhibitors and the use of generic sulfonylureas (SUs), glinides, biguanides, α-glucosidase inhibitors (α-GIs), and thiazoline derivatives, using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Furthermore, we analyzed regional differences in consultancy fees for dialysis prevention.Methods We analyzed the 2nd NDB Open Data Japan website of the Ministry of Health, Labor, and Welfare. Pearson's correlation coefficient (r) was used to evaluate the relationship between the medical costs of diabetes and each factor. The correlation coefficient was analyzed with Student's t-test, and a P-value<0.05 was considered statistically significant.Results Regarding oral hypoglycemic drugs, prefectures with a large number of DPP-4 inhibitors tended to have higher medical costs of diabetes (r=0.40, P=0.0048). Furthermore, such expenses tended to be low in prefectures where the use of generic SU drugs was high (r=-0.43, P=0.0023).Conclusions In conclusion, the results revealed regional differences in the use of DPP-4 inhibitors and generic SU drugs, which may contribute to the regional differences in medical expenses for diabetes. This study suggests that NDB open data are useful for policy making to reduce regional differences in outpatient medical costs of diabetes.


Asunto(s)
Servicios de Salud Comunitaria/economía , Costo de Enfermedad , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/economía , Inhibidores Enzimáticos/administración & dosificación , Inhibidores Enzimáticos/economía , Costos de la Atención en Salud , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/economía , Compuestos de Sulfonilurea/administración & dosificación , Compuestos de Sulfonilurea/economía , Análisis de Datos , Diabetes Mellitus/prevención & control , Dipeptidil Peptidasa 4 , Humanos , Japón , Honorarios por Prescripción de Medicamentos , Derivación y Consulta/economía
6.
West Afr J Med ; 37(3): 237-247, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32476117

RESUMEN

BACKGROUND: Type 2 diabetes mellitus can be a major drain on resources due to lifelong treatment and risk of catastrophic expenditure from treatment of complications. The prevalence has been projected to rise to alarming levels in developing countries. This study aimed to assess the levels of, and associations between good glycaemic control among patients with type 2 diabetes and their modes of financing healthcare. METHODS: In this hospital based descriptive cross-sectional study, 260 patients being managed for type 2 diabetes at the outpatient clinics of Lagos University Teaching Hospital, Lagos were recruited by systematic random sampling method. All participants received a HBA1C test to assess glycaemic control and a composite interviewer administered questionnaire adapted from the MMAS-8 and diabetes care profile to assess medication adherence, modes of financing and other factors related to disease management. RESULTS: Of the 260 study participants, 34.62% (90) had good glycaemic control. In the mode of health care financing only 15% (39) paid by health insurance (NHIS), while 85% of the respondents' payment was by out-of-pocket (OOP) payment. About half of these OOP payments were made by family, friends and others (in this study, a proxy for informal means of pooling finances). Significant associations were found between glycaemic control and adherence (2 13.93, p=0.001), glycaemic control and mode of payment (2 15.30, p=0.0000) and also adherence and mode of payment (2 16.59, p =0.002). CONCLUSION: In this study, only about a third of patients with type 2 diabetes achieved good glycaemic control, most patients used OOP financing and patients with OOP financing had poorer adherence and poorer glycaemic control. There is a need to scale up health insurance to improve health outcomes in diabetes management and protect people in developing countries from the burden of health care costs of chronic diseases like type 2 diabetes.


Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Financiación Personal/economía , Gastos en Salud/estadística & datos numéricos , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Adulto , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/economía , Femenino , Financiación Personal/estadística & datos numéricos , Hemoglobina A Glucada/análisis , Hospitales de Enseñanza , Humanos , Hipoglucemiantes/economía , Insulina/economía , Masculino , Persona de Mediana Edad , Nigeria , Factores Socioeconómicos
8.
Med Care ; 58 Suppl 6 Suppl 1: S4-S13, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32412948

RESUMEN

BACKGROUND: High deductible health plans linked to Health Savings Accounts (HSA-HDHPs) must include all care under the deductible except for select preventive services. Some employers and insurers have adopted Preventive Drug Lists (PDLs) that exempt specific classes of medications from deductibles. OBJECTIVE: The objective of this study was to examine the association between shifts to PDL coverage and medication utilization among patients with diabetes in HSA-HDHPs. RESEARCH DESIGN: A natural experiment comparing pre-post changes in monthly and annual outcomes in matched study groups. SUBJECTS: The intervention group included 1744 commercially-insured HSA-HDHP patients with diabetes age 12-64 years switched by employers to PDL coverage; the control group included 3349 propensity-matched HSA-HDHP patients whose employers offered no PDL. MEASURES: Outcomes were out-of-pocket (OOP) costs for medications and the number of pharmacy fills converted to 30-day equivalents. RESULTS: Transition to the PDL was associated with a relative pre-post decrease of $612 (-35%, P<0.001) per member OOP medication expenditures; OOP reductions were higher for key classes of antidiabetic and cardiovascular medicines listed on the PDL; the policy did not affect unlisted classes. The PDL group experienced relative increases in medication use of 6.0 30-day fills per person during the year (+11.2%, P<0.001); the increase was more than twice as large for lower-income (+6.6 fills, +12.6%, P<0.001) than higher-income (+3.0 fills, +5.1%, P=0.024) patients. CONCLUSION: Transition to a PDL which covers important classes of medication to manage diabetes and cardiovascular conditions is associated with substantial annual OOP cost savings for patients with diabetes and increased utilization of important classes of medications, especially for lower-income patients.


Asunto(s)
Seguro de Costos Compartidos/métodos , Deducibles y Coseguros , Hipoglucemiantes/economía , Ahorros Médicos , Pobreza/estadística & datos numéricos , Adolescente , Adulto , Niño , Diabetes Mellitus/economía , Diabetes Mellitus/prevención & control , Femenino , Financiación Personal/economía , Financiación Personal/estadística & datos numéricos , Humanos , Hipoglucemiantes/uso terapéutico , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pobreza/economía , Adulto Joven
9.
Value Health ; 23(4): 434-440, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32327160

RESUMEN

OBJECTIVES: Outcomes-based contracts tie rebates and discounts for expensive drugs to outcomes. The objective was to estimate the utility of outcomes-based contracts for diabetes medications using real-world data and to identify methodologic limitations of this approach. METHODS: A population-based cohort study of adults newly prescribed a medication for diabetes with a publicly announced outcomes-based contract (ie, exenatide microspheres ["exenatide"], dulaglutide, or sitagliptin) was conducted. The comparison group included patients receiving canagliflozin or glipizide. The primary outcome was announced in the outcomes-based contract: the percentage of adults with a follow-up hemoglobin A1C <8% up to 1 year later. Secondary outcomes included the percentage of patients diagnosed with hypoglycemia and the cost of a 1-month supply. RESULTS: Thousands of adults newly filled prescriptions for exenatide (n = 5079), dulaglutide (n = 6966), sitagliptin (n = 40 752), canagliflozin (n = 16 404), or glipizide (n = 59 985). The percentage of adults subsequently achieving a hemoglobin A1C below 8% ranged from 83% (dulaglutide, sitagliptin) to 71% (canagliflozin). The rate of hypoglycemia was 25 per 1000 person-years for exenatide, 37 per 1000 person-years for dulaglutide, 28 per 1000 person-years for sitagliptin, 18 per 1000 person-years for canagliflozin, and 34 per 1000 person-years for glipizide. The cash price for a 1-month supply was $847 for exenatide, $859 for dulaglutide, $550 for sitagliptin, $608 for canagliflozin, and $14 for glipizide. CONCLUSION: Outcomes-based pricing of diabetes medications has the potential to lower the cost of medications, but using outcomes such as hemoglobin A1C may not be clinically meaningful because similar changes in A1C can be achieved with generic medications at a far lower cost.


Asunto(s)
Contratos/economía , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Evaluación de Resultado en la Atención de Salud/métodos , Anciano , Canagliflozina/administración & dosificación , Canagliflozina/economía , Estudios de Cohortes , Diabetes Mellitus Tipo 2/economía , Exenatida/administración & dosificación , Exenatida/economía , Femenino , Estudios de Seguimiento , Glipizida/administración & dosificación , Glipizida/economía , Péptidos Similares al Glucagón/administración & dosificación , Péptidos Similares al Glucagón/análogos & derivados , Péptidos Similares al Glucagón/economía , Humanos , Hipoglucemiantes/economía , Fragmentos Fc de Inmunoglobulinas/administración & dosificación , Fragmentos Fc de Inmunoglobulinas/economía , Masculino , Persona de Mediana Edad , Proteínas Recombinantes de Fusión/administración & dosificación , Proteínas Recombinantes de Fusión/economía , Fosfato de Sitagliptina/administración & dosificación , Fosfato de Sitagliptina/economía
10.
Postgrad Med ; 132(4): 320-327, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32306819

RESUMEN

AIMS: This survey aimed to explore real-world physician experiences and treatment satisfaction with fast-acting insulin aspart (faster aspart) in clinical practice across Europe and Canada. MATERIALS AND METHODS: An online web-based survey was used for physicians treating people with type 1 or type 2 diabetes. General practitioners and specialists, with experience using faster aspart, were interviewed. RESULTS: A total of 191 physicians participated in the survey. Most of their patients (68% of those with T1D and 63% of those with T2D) were previously treated with another mealtime insulin before switching to faster aspart. At the time of initiating faster aspart, nearly half of patients had an HbA1c level between 7.5% (59 mmol/mol) and 8.5% (69 mmol/mol). The main prescription drivers for faster aspart, versus other mealtime insulins, were faster onset of action, improved postprandial glucose (PPG) control, and dosing flexibility. Most physicians were more satisfied with faster aspart than other mealtime insulins regarding at-meal (66%) and post-meal (71%) dosing flexibility, improved PPG levels (66%), and onset of action (61%). Main reasons for not prescribing faster aspart included a good response to current treatment (76%) or patient reluctance to switch (57%). Overall, 12% of patients discontinued faster aspart, for reasons including concerns of hypoglycemia (17%), poor adherence (17%), and level of patient co-pay (17%). More than half of physicians had fewer concerns regarding postprandial hyperglycemia, and were more confident in their patients reaching their HbA1c target with faster aspart than with other mealtime insulins. LIMITATIONS: The findings of this survey are based heavily on physicians' experiences, and could therefore be subject to recall bias. CONCLUSIONS: Reported physician and patient experiences of using faster aspart have been positive, and better PPG control and increased dosing flexibility are expected to improve glycemic management.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina Aspart/uso terapéutico , Médicos/psicología , Glucemia , Relación Dosis-Respuesta a Droga , Femenino , Financiación Personal , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemia , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/economía , Insulina Aspart/administración & dosificación , Insulina Aspart/economía , Masculino , Cumplimiento de la Medicación , Periodo Posprandial , Factores de Tiempo
11.
Drugs Aging ; 37(5): 393-398, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32227290

RESUMEN

BACKGROUND: Temporal changes in the dispensing of glucose-lowering drugs (GLD) and their associated costs among elderly populations is unclear. This information is especially relevant to countries in which medications are partly or fully government subsidized. OBJECTIVE: Our objective was to estimate the trends in prevalence, incidence and costs associated with GLD dispensed to older Australians. METHODS: We analysed Pharmaceutical Benefits Scheme data for 76,906 people aged ≥ 65 years dispensed diabetes medications over the period 2013-2016. RESULTS: Older males were dispensed more GLD than were older females, with the marginal difference increasing from 3.2% in 2013 (age-sex adjusted incidence rate ratio [aIRR] 1.032; 95% confidence interval [CI] 1.024-1.041; p < 0.001) to 3.9% in 2016 (aIRR 1.039; 95% CI 1.030-1.047; p < 0.001). The number of GLD dispensed per person was consistently lower in those aged ≥ 75 years than in those aged 65-74 years, with the gap widening over the years. More patients were initiated with sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors over the study period, at the expense of older GLD. The proportion of users and attributed costs associated with the use of metformin, sulfonylureas, α-glucosidase inhibitors and thiazolidinediones decreased over time. The total subsidized costs of GLD is forecast to increase to $A395 million by 2020. CONCLUSIONS: The treatment landscape for diabetes in Australia is undergoing dynamic change. More patients were initiated with the newer but costlier GLD over the study period.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Costos de los Medicamentos , Revisión de la Utilización de Medicamentos/tendencias , Hipoglucemiantes/uso terapéutico , Revisión de Utilización de Seguros/tendencias , Anciano , Australia/epidemiología , Glucemia/análisis , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/epidemiología , Revisión de la Utilización de Medicamentos/economía , Femenino , Humanos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/economía , Revisión de Utilización de Seguros/estadística & datos numéricos , Masculino
12.
Diabetes Res Clin Pract ; 162: 108095, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32112790

RESUMEN

AIMS: To estimate and compare the prescription costs for the management of patients with diabetes over a period of 20 years in Greece, based on real world data. METHODS: The records of outpatients with T2D, monitored at three diabetes centres, were examined in four cross-sections (1998, 2006, 2012, 2018). Prescribed medicines per patient, along with a set of clinical indicators were recorded. Annual costs of pharmaceutical treatment per patient were calculated by using each year's nominal retail prices, as well as by adjusting for 2018 price levels, in order to account for price differences over time. RESULTS: 4066 patients were included in the analysis. Prescription patterns indicate a quick uptake of the new classes of glucose-lowering drugs and a reduction in the proportional use of sulfonylurea and glitazone. Adjusting for 2018 prices, the average total annual prescription cost per patient was 381.54 Euros (s.d. 297.44) in 1998 and 1147.21 Euros (s.d. 814.39) in 2018. Glucose-lowering drug costs per patient increase from 1998 onwards, whereas the costs of antihypertensive, antiplatelet and lipid-lowering treatment declined gradually, especially after 2006. CONCLUSIONS: Per patient prescription costs for glucose-lowering drugs present a steep increase, in Greece over the last 20 years. Real-world evidence studies that compare this increase with the changes in patient outcomes are essential in order to examine whether a costs-vs-outcomes balance is optimal.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Costos de los Medicamentos/tendencias , Hipoglucemiantes/economía , Medicamentos bajo Prescripción/economía , Compuestos de Sulfonilurea/economía , Tiazolidinedionas/economía , Anciano , Costos y Análisis de Costo , Estudios Transversales , Femenino , Grecia , Humanos , Hipoglucemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Medicamentos bajo Prescripción/uso terapéutico , Compuestos de Sulfonilurea/uso terapéutico , Tiazolidinedionas/uso terapéutico
13.
Ann Pharmacother ; 54(9): 846-851, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32037850

RESUMEN

Background: Basaglar, insulin glargine (BGlar; Eli Lilly, Indianapolis, IN), a follow-on biologic, was developed after the patent for Lantus, insulin glargine (LGlar; Sanofi-Aventis, Paris, France) expired. Objective: To compare the dosing and hemoglobin A1C (A1C)-lowering effects of BGlar compared with LGlar in a real-world setting. Methods: Adult patients, at 5 clinics, with type 1 (T1DM) or type 2 diabetes mellitus (T2DM) who were converted from LGlar to BGlar were included in this retrospective observational study. The primary outcome compared mean basal insulin dose (U/d) from the date of conversion to 6 months. Basal insulin and total daily insulin doses were also compared from baseline to 3- and 12-months postconversion, as also change in A1C, body weight, and estimated monthly acquisition costs of basal insulin. Results: Of the 225 patients included, 56% were male, and 81% had T2DM. The mean conversion dose (U/d) of LGlar was 46.3 ± 32.7. There was no significant difference in the mean BGlar dose (U/d) at 6 months (45.9 ± 33.5; P = 0.52), nor was there a statistical difference at 3 or 12 months. There were no significant differences in change in A1C at any time point. The estimated monthly acquisition cost of BGlar was significantly less than that for LGlar at conversion ($286 vs $341, P < 0.001) and 6 months ($290 vs $351, P < 0.001) respectively. Conclusion/Relevance: The results of this retrospective study suggest that BGlar resulted in similar glycemic outcomes compared with LGlar in a real-world setting and may be a preferable option in a value-based health care environment.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Medicamentos Genéricos/administración & dosificación , Hipoglucemiantes/administración & dosificación , Insulina Glargina/administración & dosificación , Adulto , Glucemia/análisis , Peso Corporal/efectos de los fármacos , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/sangre , Sustitución de Medicamentos , Medicamentos Genéricos/economía , Medicamentos Genéricos/uso terapéutico , Femenino , Francia , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Illinois , Insulina Glargina/economía , Insulina Glargina/uso terapéutico , Masculino , Persona de Mediana Edad , Honorarios por Prescripción de Medicamentos , Estudios Retrospectivos
14.
Adv Ther ; 37(3): 1248-1259, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32048148

RESUMEN

INTRODUCTION: Once-weekly semaglutide 1 mg is a novel glucagon-like peptide 1 receptor agonist (GLP-1 RA) that, in the SUSTAIN clinical trials, has demonstrated greater reductions in glycated haemoglobin (HbA1c) and body weight than the other GLP-1 RAs exenatide extended-release (ER) 2 mg, dulaglutide 1.5 mg and liraglutide 1.2 mg. The aim of this analysis was to evaluate the relative cost of control of achieving treatment goals in people with type 2 diabetes (T2D) treated with once-weekly semaglutide versus exenatide ER, dulaglutide and liraglutide from a UK perspective. METHODS: Proportions of patients reaching HbA1c targets (< 7.0% and < 7.5%), weight loss targets (≥ 5% reduction in body weight) and composite endpoints (HbA1c < 7.0% without weight gain or hypoglycaemia; reduction in HbA1c of ≥ 1% and weight loss of ≥ 5%) were obtained from the SUSTAIN clinical trials. Annual per patient treatment costs were based on wholesale acquisition costs from July 2019 in the UK. Cost of control was calculated by plotting relative treatment costs against relative efficacy. RESULTS: The annual per patient cost was similar for all GLP-1 RAs. Once-weekly semaglutide was superior to exenatide ER, dulaglutide and liraglutide in bringing patients to HbA1c and weight loss targets, and to composite endpoints. When looking at the composite endpoint of HbA1c < 7.0% without weight gain or hypoglycaemia, exenatide ER, dulaglutide and liraglutide were 50.0%, 21.6% and 51.3% less efficacious in achieving this, respectively, than once-weekly semaglutide. Consequently, the efficacy-to-cost ratios for once-weekly semaglutide were superior to all comparators in bringing patients to all endpoints. CONCLUSIONS: The present study showed that once-weekly semaglutide offers superior cost of control versus exenatide ER, dulaglutide and liraglutide in terms of achieving clinically relevant, single and composite endpoints. Once-weekly semaglutide 1 mg would therefore represent good value for money in the UK setting.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Péptidos Similares al Glucagón/economía , Péptidos Similares al Glucagón/uso terapéutico , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Peso Corporal , Análisis Costo-Beneficio , Esquema de Medicación , Exenatida/economía , Exenatida/uso terapéutico , Femenino , Péptidos Similares al Glucagón/administración & dosificación , Péptidos Similares al Glucagón/análogos & derivados , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/administración & dosificación , Fragmentos Fc de Inmunoglobulinas/economía , Fragmentos Fc de Inmunoglobulinas/uso terapéutico , Liraglutida/economía , Liraglutida/uso terapéutico , Masculino , Persona de Mediana Edad , Proteínas Recombinantes de Fusión/economía , Proteínas Recombinantes de Fusión/uso terapéutico , Reino Unido , Aumento de Peso
15.
Curr Diabetes Rev ; 16(8): 851-858, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32026779

RESUMEN

BACKGROUND: The vast majority of individuals diagnosed with diabetes are low/middle income and may have access to only three of the 11 oral hypoglycemic medications (OHMs) due to cost: metformin intermediate release (IR) or extended release (ER), sulfonylureas (glimepiride, glipizide, glyburide), and pioglitazone. Sulfonylureas and pioglitazone have had significant controversy related to potential adverse events, but it remains unclear whether these negative outcomes are class, drug, or dose-related. OBJECTIVE: We conducted a narrative review of low-cost OHMs. METHODS: We evaluated the maximum recommended (MAX) compared to the most effective (EFF) daily dose, time-to-peak change in HbA1c levels, and adverse events of low-cost oral hypoglycemic medications. RESULTS: We found that the MAX was often greater than the EFF: metformin IR/ER (MAX: 2,550/2,000 mg, EFF: 1,500-2,000/1,500-2,000 mg), glipizide IR/ER (MAX: 40/20 mg, EFF: 20/5 mg), glyburide (MAX: 20 mg, EFF: 2.5-5.0 mg), pioglitazone (MAX: 45 mg, EFF: 45 mg). Time-to-peak change in HbA1c levels occurred at weeks 12-20 (sulfonylureas), 25-39 (metformin), and 25 (pioglitazone). Glimepiride was not associated with weight gain, hypoglycemia, or negative cardiovascular events relative to other sulfonylureas. Cardiovascular event rates did not increase with lower glyburide doses (p<0.05). Glimepiride and pioglitazone have been successfully used in renal impairment. CONCLUSION: Metformin, glimepiride, and pioglitazone are safe and efficacious OHMs. Prescribing at the EFF rather than the MAX may avoid negative dose-related outcomes. OHMs should be evaluated as individual drugs, not generalized as a class, due to different dosing and adverse-event profiles; Glimepiride is the preferred sulfonylurea since it is not associated with the adverse events as others in its class.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Administración Oral , Costo de Enfermedad , Diabetes Mellitus Tipo 2/complicaciones , Quimioterapia Combinada , Humanos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Insulinas/administración & dosificación , Insulinas/efectos adversos , Insulinas/economía , Insulinas/uso terapéutico , Metformina/administración & dosificación , Metformina/efectos adversos , Metformina/economía , Metformina/uso terapéutico , Compuestos de Sulfonilurea/administración & dosificación , Compuestos de Sulfonilurea/efectos adversos , Compuestos de Sulfonilurea/economía , Compuestos de Sulfonilurea/uso terapéutico , Tiazolidinedionas/administración & dosificación , Tiazolidinedionas/efectos adversos , Tiazolidinedionas/economía , Tiazolidinedionas/uso terapéutico
17.
J Manag Care Spec Pharm ; 26(2): 154-159, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32011961

RESUMEN

BACKGROUND: Statutory rebates and preferred drug lists (PDLs) may result in differential use of biosimilars and generics between Medicaid fee-for-service (FFS) and managed care organizations (MCOs), particularly for branded drugs with large price increases subject to large inflation rebates, which are not retained by MCOs. OBJECTIVE: To compare the use of 2 biosimilar/generics of branded drugs whose list price tripled in 2008-2018 across states with only FFS Medicaid, with MCOs not subject to statewide PDLs, with MCOs subject to statewide PDLs, and with MCOs where drug benefits have been carved out. METHODS: Using 2018 Medicaid drug utilization data, we extracted reimbursement records in Q1-Q3 2018 for insulin glargine 100 IU/mL and glatiramer. We calculated the market share of the biosimilar insulin glargine and generic glatiramer among the corresponding drugs. We compared the market share of these products across 4 state groups: states with only FFS Medicaid, states with MCOs not subject to statewide PDLs for each drug, states with MCOs subject to PDLs, and states with MCOs where drug benefits have been carved out into FFS. We evaluated the correlation between state-level penetration of MCOs and share of biosimilar/generic products. RESULTS: Nationally, the market share of these biosimilar/specialty generics was higher among MCOs than FFS (60.5% vs. 3.7% for biosimilar insulin glargine; 59.4% vs. 5.7% for generic glatiramer; all P < 0.001). The market share of these products was highest in states where MCOs were not subject to statewide PDLs for these drugs (59.1% for biosimilar insulin glargine, 52.8% for glatiramer) compared with states with MCOs subject to PDLs (2.4%, 18.0%); states with only FFS Medicaid (0.9%, 1.7%); or states where drug benefits have been carved out of MCOs (0.0%, 1.0%; all P < 0.001). There was a significant correlation between state-level MCO penetration and share of generic/biosimilar products (R = 0.50 for biosimilar insulin glargine and 0.57 for glatiramer; all P < 0.001). CONCLUSIONS: For 2 drug classes with large price increases, use of biosimilars/generics was greater in MCOs than FFS Medicaid, specifically in states without PDL requirements for MCOs. These findings may reflect financial incentives for MCOs to use drugs with lower list prices because they do not benefit from statutory Medicaid rebates. DISCLOSURES: No outside funding supported this study. Hernandez was funded by the National Heart, Lung and Blood Institute (grant number K01HL142847). The authors have nothing to disclose.


Asunto(s)
Acetato de Glatiramer/economía , Insulina Glargina/economía , Programas Controlados de Atención en Salud/economía , Medicaid/economía , Biosimilares Farmacéuticos/administración & dosificación , Biosimilares Farmacéuticos/economía , Costos de los Medicamentos , Medicamentos Genéricos/administración & dosificación , Medicamentos Genéricos/economía , Planes de Aranceles por Servicios/economía , Acetato de Glatiramer/administración & dosificación , Humanos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/economía , Insulina Glargina/administración & dosificación , Estados Unidos
20.
Curr Diab Rep ; 20(1): 2, 2020 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-31997036

RESUMEN

PURPOSE OF REVIEW: High insulin prices and cost-related insulin underuse are increasingly common and vexing problems for healthcare providers. This review highlights several factors that contribute to high prices and limited generic competition in the US insulin market. RECENT FINDINGS: An opaque and complex pricing and reimbursement system for insulin, allegations of collusive practices by insulin manufacturers, and a lack of generic competition drive and sustain high insulin prices. When combined with increasing insurance deductibles and cost sharing, these factors contribute to cost-related insulin underuse and are associated with adverse clinical outcomes. Healthcare providers facing patients with type 2 diabetes who struggle to afford insulin should consider initiating or switching from analogue to human insulin as one way to help address the challenges of access and affordability. However, it is also important to support initiatives to advocate for affordable pricing for insulin for patients who can benefit from the flexibility offered by many of the newer insulin preparations.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Costos de los Medicamentos , Mal Uso de los Servicios de Salud/economía , Hipoglucemiantes/economía , Insulina/economía , Control de Costos/legislación & jurisprudencia , Costos y Análisis de Costo , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/epidemiología , Costos de los Medicamentos/legislación & jurisprudencia , Medicamentos Genéricos/economía , Medicamentos Genéricos/uso terapéutico , Competencia Económica , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico
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