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A comparison of costs among patients with type 2 diabetes mellitus who initiated therapy with exenatide or insulin glargine

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Abstract

Background

Exenatide (Byetta®) and insulin glargine (Lantus®) are antidiabetic agents that are typically used after lack of response to an oral antidiabetic agent(s). Although previous research has examined the impact of these medications on glycaemic control, there is little information about the relative costs associated with the medications.

Objective

To compare costs among patients with type 2 diabetes mellitus treated with exenatide or insulin glargine from a US third-party payer perspective.

Methods

Data from a large, national administrative claims database were used in this study. The intent-to-treat (ITT) cohort included adults who were diagnosed with type 2 diabetes and initiated therapy with either exenatide (n = 4090) or insulin glargine (n = 1660). In addition, included patients were required to have no diagnoses of type 1 diabetes, to have received at least two prescriptions for an oral antidiabetic agent in the 6 months prior to first use of either exenatide or insulin glargine and to have continuous insurance coverage from 6 months before, to 12 months after, initiation on ITT medication.

Annual total medical costs and total diabetes-related medical costs, in $US, year 2007 values, were estimated using stepwise multivariate regressions. Major cost components were also examined using either stepwise multivariate regressions or a two-part model that controlled for the probability of using the service. Smearing estimates were used to transform estimated log costs into costs. The analysis controlled for the potential impact of patient demographics, general health, prior resource use, co-morbidities and complications, and timing of treatment initiation.

Results

Compared with insulin glargine, initiation of exenatide was associated with significantly lower total direct medical costs ($US19 293 vs $US23 782; p < 0.0001), inpatient costs ($US4121 vs $US7532; p < 0.0001), outpatient costs ($US9501 vs $US12 885; p < 0.0001), emergency department (ED) costs ($US82 vs $US131; p < 0.0001), total diabetes-related medical costs ($US7833 vs $US8536; p < 0.0001), diabetes-related inpatient costs ($US2172 vs $US3538; p <0.0001) and diabetes-related outpatient costs ($US2739 vs $US3249; p < 0.0001). Initiation of exenatide was associated with significantly higher total overall drug costs ($US6885 vs $US5936; p < 0.0001) and diabetes-related drug costs ($US3160 vs $US2422; p < 0.0001).

Conclusions

Compared with the use of insulin glargine, use of exenatide was associated with significantly lower annual total direct medical costs and significantly lower total diabetes-related medical costs, despite higher total drug costs and higher diabetes-related drug costs. In addition, exenatide was associated with significantly lower total inpatient, outpatient, ED, and diabetes-related inpatient and outpatient costs.

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Acknowledgements

Funding for this study was provided by Eli Lilly and Company.

Eli Lilly and Company provided funding for conducting the study to HealthMetrics Outcomes Research, of which Maureen J. Lage is an employee. Derek Misurski and Kristina S. Boye are employees and shareholders of Eli Lilly and Company, and were compensated for work on this project. Rosalind Fabunmi was an employee of Amylin Pharmaceuticals at the time this work was carried out and has stock options with Amylin Pharmaceuticals. Employees of Lilly and Amylin reviewed the manuscript prior to submission for publication.

The authors gratefully acknowledge the assistance of Patricia Platt in help with drafting the manuscript.

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Authors and Affiliations

  1. Eli Lilly and Company, Indianapolis, Indiana, USA

    Derek Misurski & Kristina S. Boye

  2. HealthMetrics Outcomes Research, LLC, 120 Anchorage Circle, Groton, CT, 06340, USA

    Maureen J. Lage

  3. Amylin Pharmaceuticals Inc., San Diego, California, USA

    Rosalind Fabunmi

Authors
  1. Derek Misurski
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  2. Maureen J. Lage
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  3. Rosalind Fabunmi
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  4. Kristina S. Boye
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Correspondence to Maureen J. Lage.

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Misurski, D., Lage, M.J., Fabunmi, R. et al. A comparison of costs among patients with type 2 diabetes mellitus who initiated therapy with exenatide or insulin glargine. Appl Health Econ Health Policy 7, 245–254 (2009). https://doi.org/10.1007/BF03256158

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