gms | German Medical Science

15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

20.11. - 21.11.2008, Bonn

Comparison of treatment costs in insulin-dependent patients with type 2 diabetes mellitus under real world conditions in Germany: LIVE-SPP Study

Behandlungskostenvergleich insulinpflichtiger Typ-2-Diabetiker im deutschen Versorgungsalltag: Ergebnisse der LIVE-SPP-Studie

Meeting Abstract

  • O. Schöffski - Universität Erlangen-Nürnberg, Erlangen, Germany
  • corresponding author F.W. Dippel - Sanofi-Aventis Deutschland GmbH, Berlin, Germany
  • K.H. Theobald - Sanofi-Aventis Deutschland GmbH, Berlin, Germany
  • M. Müller - axaris software & systeme GmbH, Ulm, Germany
  • L. Breitscheidel - Kendle, München, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 15. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Bonn, 20.-21.11.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08gaa25

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gaa2008/08gaa25.shtml

Veröffentlicht: 6. November 2008

© 2008 Schöffski et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: To assess and compare the annual total costs relevant to diabetes care in insulin-dependent patients with type 2 diabetes mellitus (T2D) treated with either insulin glargine (GLA)- or conventional basal insulin (NPH)-based therapies.

Methods: LIVE-SPP (Long acting Insulin glargine Versus NPH Cost Evaluation in SPecialised Practices) study is a comparative, multicenter, non-interventional, retrospective cost evaluation in adults with T2D treated at specialised diabetologists practices in KV Nordrhein and KV Westfalen-Lippe. Data were extracted directly from the database systems used by the diabetologists. Data evaluated in this study were on patients with T2D, pre-treated with insulin for a maximum of 24 months, and being on the same treatment regimen with either GLA- or NPH-based therapies for at least 12 months without interruption.

In addition, only patients with complete data on T2D treatment for at least 4 quarters were included. The pharmacoeconomic analyses were carried out according to the cost-minimisation approach from the perspective of the German statutory health insurance (SHI) based on prices of 2005.

Average treatment costs for both study cohorts were assessed. The following resource categories were recorded and costed: prescribed medication (e.g. insulin, oral anti-diabetic drugs), diabetes-related materials (pens, needles, test stripes, and lancets), prescribed therapeutic devices and adjuvants (e.g. orthopaedic shoes, blood glucose- and blood pressure measurement devices), diabetes training sessions, visits to treating physician, referrals to specialists and hospitalisations. The possible influence of the baseline parameters (age, gender, body-mass-index (BMI), glycosylated hemoglobine (HbA1c), fasting blood glucose (FBG), duration of diabetes and insulin pre-treatment, number of diabetic complications) on the costs was assessed using univariate linear modelling. Variables with significant impact on costs were tested using multivariate linear modelling (GLM) and adjusted for in the final cost comparison between the both cohorts. One-way sensitivity analyses were performed by varying the main cost factors by ±25%.

Results: The mean duration of documentation was about 20 months. Documentation period lasted from 01.01.03 to 31.03.06. The overall population comprised 1024 patients (512 per study cohort).

On average, both cohorts did not differ regarding the sociodemographic, treatment history and clinical parameters at baseline: age (62 years), gender (55% men), BMI (30,5 kg/m²), HbA1c (7,96%), FBG (171 mg/dl), mean diabetes duration (8 years) or duration of insulin pre-treatment (7 months). The proportion of patients with two or more diabetic complications was significantly higher (p<0.0001) in the insulin glargine group compared to the NPH-insulin group (94% and 88%, respectively). In addition, number of diabetic complications was the only variable that had a significant influence on costs.

The mean unadjusted annual total costs per patient were 1.868 € [95%CI 1744.27-1992.56] for GLA and 2.064 € [95% 1922.91-2204.54] for NPH. The annual total costs per-patient adjusted by the number of diabetic complications were 1.241 € for GLA and 1.608 € for NPH (p=0.0004). The main cost factors in both study cohorts were insulin prescriptions, visits to physicians and blood glucose self testing materials. The economic advantage for GLA remained stable in sensitivity analyses.

Conclusion: This cost comparison analysis shows an economic advantage for insulin glargine based therapies compared to NPH-based therapies. The savings for the SHI per patient and year are 196 € (unadjusted) and 367 € (adjusted).