Elizabeth L. Eby

Cost, healthcare resource utilization, and adherence of individuals with diabetes using U-500 or U-100 insulin: a retrospective database analysis

Abstract Objective: To describe costs, healthcare resource utilization, and adherence of US patients receiving human regular U-500 insulin (U-500R), compared to patients receiving high-dose (>200 units/day) U-100 insulins (U-100) by subcutaneous injection for the treatment of diabetes. Methods: A retrospective analysis of data from Thomson Reuters MarketScan Research Databases (7/1/2008 to 12/31/2010). Difference-in-differences analyses were conducted on cost (medical, pharmacy, and overall costs) and on healthcare resource utilization variables (overall, diabetes-related, and non-diabetes-related medical visits). Adherence rates to the index insulins were assessed by proportion of days covered (PDC). Results: Seven hundred and eleven (19%) patients in the U-500R cohort and 1508 (6%) patients in the U-100 cohort met selection criteria. Propensity score matching resulted in 684 matched pairs. Mean change in annualized pharmacy costs was in favor of the U-500R vs the U-100 cohort (−

Predictors of 30 day hospital readmission in patients with type 2 diabetes: a retrospective, case–control, database study

1258 vs

Healthcare costs and adherence associated with human regular U-500 versus high-dose U-100 insulin in patients with diabetes.

3345, a difference of −

Incidence, prevalence, and trend analysis of the use of insulin delivery systems in the United States (2005 to 2011)

4603, p < 0.0001). Mean overall cost increase in the U-500R vs the U-100 cohort was also lower (

Initiation of human regular U-500 insulin use is associated with improved glycemic control: a real-world US cohort study

1999 vs

The association between use of mealtime insulin pens versus vials and healthcare charges and resource utilization in patients with type 2 diabetes: a retrospective cohort study

9104, a difference of −

Cost-effectiveness of TYRX absorbable antibacterial envelope for prevention of cardiovascular implantable electronic device infection

7105, p = 0.005). The proportion of patients with at least one coded hypoglycemic event during the 12-month post-index period was higher in the U-500R vs the U-100 cohort (17.1% vs 11.7%, p < 0.005), but neither hypoglycemia rate (2.73 vs 2.90 events per person) nor hypoglycemia-specific costs (mean

Insulin Dosing and Outcomes Among Commercially Insured Patients With Type 2 Diabetes in the United States

1669 vs

Dosing of U-100 insulin and associated outcomes among Medicare enrollees with type 1 or type 2 diabetes

1543) were significantly different. No significant differences were noted between cohorts for change (post–pre) in any resource utilization category. PDC was greater in the U-500R vs the U-100 cohort (65.2% vs 39.5%, p < 0.0001). Limitations: Claims data are not as accurate as empirical evaluation by a clinician. Glycemic control data were not available for this analysis. Conclusions: In patients requiring high-dose insulin, treatment with U-500R vs high-dose U-100 insulins is associated with significant decreases in pharmacy and overall costs, slightly higher hypoglycemia incidence, no difference in hypoglycemia-specific costs or in resource utilization, and better adherence.

Glycemic control and the first use of oral antidiabetic agents among patients with type 2 diabetes mellitus

Abstract Objective: To assess factors predictive of all-cause, 30 day hospital readmission among patients with type 2 diabetes in the United States. Methods: A retrospective, case–control study using deidentified Humedica electronic health record data was conducted to identify patients ≥18 years old with ≥6 months of data prior to index hospitalization (pre-period) and ≥30 days of data after discharge (post-period). Combined methods of bootstrap resampling and stepwise logistic regression were used to identify factors associated with readmission. Results: Among 52,070 patients with type 2 diabetes and an initial hospitalization for any reason, 5201 (10.0%) patients were readmitted within 30 days and 46,869 (90.0%) patients showed no evidence of readmission. Diabetic treatment escalation; race; type 2 diabetes diagnosis prior to the index stay; pre-period heart failure; and number of pre-period, inpatient healthcare visits were among the strongest predictors of 30 day readmission. From a receiver-operating characteristic plot (mean area under curve of 0.693), the predictive accuracy of the final logistic regression model is considered modest. This result might be due to the unavailability of some variables or data. Conclusions: These results highlight the importance of the appropriate recognition of and treatment for type 2 diabetes, prior to and during hospitalization and following discharge, in order to impact a subsequent hospitalization. In our analysis, escalation of diabetic treatments (especially those escalated from having no records of anti-diabetic medications to treatment with insulin) was the strongest predictor of 30 day readmission. Limitations of this study include the fact that hospitalizations and other encounters, outside the Humedica network, were not captured in this analysis.