Michael F. Pollack

Patient-reported tolerability issues with oral antidiabetic agents: Associations with adherence; treatment satisfaction and health-related quality of life.

AIMS The studys aim was to quantify prevalence of tolerability issues among patients with T2DM currently treated with OADs and to assess its association with treatment adherence, satisfaction and health-related quality of life (HRQL). METHODS Data were collected from the 2006-2008 US National Health and Wellness Survey and the Ailment Panel of Lightspeed Online Research, an internet-based questionnaire. Participants (N=2074) self-reported a diagnosis of T2DM, were >18 years of age and currently taking >1 OADs but not insulin, and spoke English. RESULTS The majority (71.7%) experienced at least 1 tolerability issue in the past 2 weeks; 49.7% experienced >2. Tolerability issues included signs/symptoms of hypoglycemia (57.2%), constipation/diarrhea (28%), headaches (25.6%), weight gain (22.9%) and water retention (21.0%). There was a significant association between the number of tolerability issues and both the likelihood of non-adherence (r=0.20, p<0.01) and reduced treatment satisfaction (r=-0.42, p<0.01). Each additional tolerability issue was associated with 28% greater likelihood of medication non-adherence. Constipation/diarrhea (b=-0.02, p<0.01) and symptoms of hypoglycemia (b=-0.08, p<0.01) were significantly associated with lower HRQL scores. CONCLUSIONS Optimizing OAD therapy of T2DM by improving tolerability may increase patient satisfaction, medication adherence and HRQL, and may increase the likelihood of attaining treatment goals.

Effects of hypoglycemia on health-related quality of life, treatment satisfaction and healthcare resource utilization in patients with type 2 diabetes mellitus

AIMS To quantify patient-reported rates of hypoglycemia and its association with health-related quality of life (HRQL), treatment satisfaction, and healthcare resource utilization. METHODS Data were collected from 2006 to 2008 US National Health and Wellness Survey and the Ailment Panel of Lightspeed Online Research, an internet-based questionnaire. Adults (≥ 18 years) with type 2 diabetes taking ≥ 1 oral antidiabetic agent (OAD), but not insulin, were included (n=2074). Multivariate analyses included logistic regression and generalized linear models. RESULTS Overall, patients who reported experiencing hypoglycemia symptoms (n=286; 13.78%) were significantly more likely to have a lower HRQL on several parameters including: increased limitations on mobility (b=0.66, OR=1.93, p<0.0001) and usual activities (b=0.58, OR=1.78, p<0.0001), increased pain/discomfort (b=0.69, OR=2.00, p<0.0001) and anxiety/depression (b=0.84, OR=2.31, p<0.0001). They also had a lower total treatment satisfaction score as measured by the DiabMedSat tool (b=-7.66, p<0.0001). Self-reported rates of diabetes-related emergency room (b=0.98, p=0.004) and physician visits (b=0.30, p<0.0001) were also higher among these patients. CONCLUSION Among OAD-treated type 2 diabetes patients, symptoms of hypoglycemia tend to be correlated with significantly lower HRQL, lower treatment satisfaction and higher levels of healthcare resource utilization.

Insomnia-related comorbidities and economic costs among a commercially insured population in the United States

ABSTRACT Objective: To describe the association between insomnia and comorbid conditions, and subsequent effects on total health costs and work productivity in a large managed-care setting. Methods: Administrative claims data from a large commercially insured population were reviewed for patients with a prescription claim for an insomnia medication or an insomnia-related medical diagnosis, between 1/1/2001 and 12/30/2003. A control group of patients having no insomnia-related medical or prescription claim was identified within this same time period. Propensity score matching methods were used to reduce observed biases between cohorts. Economic costs and comorbidities were evaluated using t-tests for bivariate comparisons, negative-binomial regression to assess the degree of comorbidity, Wilcoxon–Mann–Whitney test for cost outcomes and generalized linear models for multivariate cost comparisons. Results: Among both unmatched and matched cohorts, insomnia patients had statistically higher rates of depression, anxiety/phobia, stress, and head pain compared to the controls. After adjusting for patient covariates, insomnia patients had higher predicted healthcare and productivity costs than a cohort of matched control patients (

Costs Of Severely Ill Members And Specialty Medication Use In A Commercially Insured Population

4434 vs.

An economic evaluation of therapeutic alteration in the management of insomnia

3576; p < 0.001). Conclusion: Though identified patients were required to have enrollment in both medical and productivity databases, and the presence of insomnia could not be verified through medical records, these results suggest a significant link between insomnia and higher rates of comorbid conditions, healthcare expenditures and productivity losses. Payers and employers should consider insomnia as a factor in disease-related case-management initiatives.

PDB47 THE ASSOCIATION BETWEEN PATIENT-REPORTED DIABETES SYMPTOMS AND TOLERABILITY ISSUES OF ORAL ANTIDIABETIC AGENTS ON WORK AND LIFE PRODUCTIVITY

This study examines the overall profile and costs associated with severely ill commercially insured people. We found severely ill members to have the highest costs, from both the insurer and member perspective. Even for the most costly members where specialty medication use was highest, biologics represented less than one-third of the pharmacy spending and 6.6 percent of overall spending. Out-of-pocket spending rose dramatically when medications were paid for under the pharmacy benefit rather than the medical benefit. The advantages of paying for specialty medications under the pharmacy benefit should be evaluated in conjunction with the potential consequences of increased out-of-pocket burden.

Association between short-term effectiveness of statins and long-term adherence to lipid-lowering therapy

ABSTRACT Objectives: The economic impact of switching patterns from older drug treatment for the management of insomnia has not been thoroughly investigated. The objective of this study was to examine the economic burden of therapeutic alterations for the treatment of insomnia. Methods: Treated insomnia patients were identified from the Medstat Marketscan claims database who had at least one prescription for insomnia agents during the study period (05/01/01 to 11/30/03). A change in therapy was defined as having a recorded prescription for an insomnia treatment other than the index study medication during the post-index period, which included overlapping augmentation or complete therapy switch. Economic costs included direct medical and pharmacy expenditures. One-year follow-up costs were compared using Wilcoxon tests for bivariate analyses and generalized linear models with gamma functions for multivariate comparisons. Results: Approximately 88% of the sample had no change in insomnia treatment. Patients on monotherapy (n = 24540) differed from patients altering therapy (n = 3267) with respect to age, gender and baseline Deyo–Charlson score. Patients altering therapy had a higher frequency of insomnia diagnoses (22 vs. 11%; p < 0.001) and comorbid depression or anxiety (21–45 vs. 12–25%; p < 0.001) than patients who did not alter therapy. Patients who changed therapy had approximately 67% higher (p < 0.001) direct medical costs compared to those who did not. Limitations of the study include observational study design, and lack of complete availability of all possible risk adjusters for clinical severity. Conclusion: Total direct medical costs were significantly higher in patients who altered therapy in a year compared to maintainers after controlling for baseline differences.

PCV32 Population Attributable Risk (PAR) of Macrovascular Events Associated with HbA1C, Blood Pressure or Weight in Patients with Type 2 Diabetes Mellitus: Evidence from a Dutch Cohort

INTRODUCTION • It is currently estimated that 8% (23.6 M) of all Americans have diagnosed T2DM.1 The incidence and prevalence of T2DM are on the rise in the U.S. • Indirect costs of diabetes total

PDB18 Population Attributable Risk of Microvascular Events Associated With HbA1C, Blood Pressure or Weight in Patients With Type 2 Diabetes Mellitus

58 billion and include increased absenteeism and presenteeism (reduced productivity at work) among the employed, removal from the labor force as a result of disease-related disability and mortality, and reduced life productivity for those not in the labor force.2 • Although glycemic control has improved over time, a large proportion of patients with T2DM continue to have inadequate glucose control.3 • Several safety and tolerability issues are associated with OADs.3,4 • Diabetes symptoms and tolerability issues of existing treatments may affect work productivity, further contributing to the overall burden of T2DM.