ABSTRACT: To determine the impact on insulin acquisition cost of a pharmacy program to convert insulin utilization from multidose vials to pen-delivery systems for long-term care residents covered by Medicare Part A, and managed care plans.
Retrospective cost comparison.
Long-term care facilities.
Residents covered by Medicare Part A and managed care plans.
Policy to replace insulin vials with pen devices, effective July 2009.
Mean insulin cost-per-patient day (total insulin purchases divided by patient admission days) and pen utilization (pen purchases as a percent of total insulin purchases).
Insulin purchase data covered 2,405 admissions in 75 facilities over the 12-month period ending June 2010. Pen device purchases increased from less than 1% to almost 35% of total insulin purchases over the study period during which insulin cost per patient-day declined from $10.29 to $4.08. For Medicare Part A patients with admissions of 30 days or fewer, the most frequent visit type, mean cost per patient-day decreased from $13.73 to $9.19 as pen purchases increased from less than 1% to about 32%. For these same patients, mean cost per patient-day for admissions using only pen devices was $7.04, compared with $11.79 for admissions using only vials (P < 0.001). Significant differences in mean cost per patient-day were also found for residents covered by managed care and for longer admissions.
Total insulin costs can be reduced through higher utilization of pen devices by patients in long-term care facilities.
The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists 06/2012; 27(6):411-20.
ABSTRACT: Insulin pump users discard unused medication and infusion sets according to labeling and manufacturer's instructions. The stability labeling for insulin aspart (rDNA origin] (Novolog) was increased from two days to six. The associated savings was modeled from the perspective of a hypothetical one-million member health plan and the total United States population.
The discarded insulin volume and the number of infusion sets used under a two-day stability scenario versus six were modeled.
A mix of insulin pumps of various reservoir capacities with a range of daily insulin dosages was used. Average daily insulin dose was 65 units ranging from 10 to 150 units. Costs of discarded insulin aspart [rDNA origin] were calculated using WAC (Average Wholesale Price minus 16.67%). The cost of pump supplies was computed for the two-day scenario assuming a complete infusion set change, including reservoirs, every two days. Under the six-day scenario complete infusion sets were discarded every six days while cannulas at the insertion site were changed midway between complete changes. AWP of least expensive supplies was used to compute their costs.
For the hypothetical health plan (1,182 pump users) the annual reduction in discarded insulin volume between scenarios was 19.8 million units. The corresponding cost reduction for the plan due to drug and supply savings was $3.4 million. From the U.S. population perspective, savings of over $1 billion were estimated.
Using insulin that is stable for six days in pump reservoirs can yield substantial savings to health plans and other payers, including patients.
Managed care (Langhorne, Pa.) 05/2011; 20(5):42-7.
ABSTRACT: Poor glycemic control in hospitalized patients has been associated with increased morbidity and mortality. Research suggests that analogue bolus insulin may be more effective in achieving blood glucose (BG) control compared with human bolus insulin.
This study compares mortality, length of stay (LOS), costs, and BG control in hospitalized patients receiving either analogue or human bolus insulin.
This retrospective cohort analysis used data from January 1, 2004, to December 31, 2007, within the Health Facts database (Cerner Corporation, Kansas City, Missouri). Nonsurgical adult patients who received exclusively analogue or human bolus insulin during hospitalization were included in the study. Propensity score matching and multivariate regression analyses were used to compare patients treated with analogue versus human bolus insulin. The study outcomes were in-hospital mortality, hospital LOS among survivors (to avoid potentially short hospitalizations among nonsurvivors distorting results), and hospitalized BG control (present vs absent), defined as having a mean BG of 70 to <200 mg/dL during hospitalization.
In total, 35,049 participants met the inclusion criteria and 5568 of 7754 patients in the analogue group were matched by their propensity scores to patients in the human bolus group (mean age, 67.1 years; 53% women; 77% white). On propensity score analysis, analogue bolus insulin was associated with lower mortality (relative risk [RR] = 0.52; 95% CI, 0.45-0.61) and shorter LOS (0.668-day reduction; 95% CI, 0.44-0.89) compared with human bolus insulin. However, analogue insulin was associated with only a modest benefit for BG control (RR = 0.88; 95% CI, 0.81-0.95). The multivariate regression analysis produced similar findings.
In this cohort of hospitalized patients, analogue bolus insulin was associated with lower mortality, shorter LOS, and modestly better BG control compared with patients treated with human bolus insulin. These results highlight the need for a randomized controlled clinical trial comparing outcomes by bolus insulin type in the hospital setting to determine a true mortality benefit.
Clinical Therapeutics 10/2010; 32(11):1954-66. · 2.32 Impact Factor
ABSTRACT: To estimate and compare the annual direct healthcare cost among Type 1 (T1DM) and Type 2 (T2DM) diabetes patients using two cost estimation methods: (1) DM-attributable cost and (2) all cause case-control cost.
An administrative claims cohort study using the HealthCore Integrated Research Database (HIRD(R)) identified T1DM and T2DM patients age >or=18 and <65 years between 1/1/2006 - 12/31/2006. DM patients (cases) were matched 1:1 with non-DM patients (controls) by age, gender, state, and commercial plan type (HMO, PPO, POS). All patients had continuous eligibility for calendar years 2006-07. DM-attributable cost was assessed by summing medical claims for DM (ICD-9-CM codes 250.xx) and pharmacy claims for anti-hyperglycemic agents, and all cause health care cost was assessed for cases and controls, for the calendar year 2007.
A total of 12,096 T1DM and 256,245 T2DM cases and matched controls were identified. T1DM and T2DM cases had significantly higher average baseline comorbidities and Deyo-Charleson Comorbidity scores than controls (2.17 vs. 0.23 and 1.62 vs. 0.39, respectively, p < 0.0001 for both).While DM attributable cost estimation resulted in a mean annual cost of $6247 for T1DM and $3002 for T2DM in 2007, the mean annual (per patient) all-cause total cost estimation using the case-control method resulted in a difference of $10,837 ($14,060 for cases, vs. $3223 for controls) for T1DM; and $4217 ($8070 for cases, vs. $3853 for controls) for T2DM.
The DM-attributable cost method underestimated costs by 42% for T1DM and 29% for T2DM compared to the case-control method. The difference was smaller but still significant (33% for T1DM and 14% for T2DM) when multivariate technique was used. Patients with DM may use a substantial amount of medical and pharmacy services not directly attributable to DM, and attributable cost method may underestimate the total cost of DM. This study has limitations inherent to the retrospective claims data analysis and generalizability of results is limited to those from similar population.
Current Medical Research and Opinion 08/2010; 26(8):1827-34. · 2.38 Impact Factor
ABSTRACT: To assess the relationship between cost sharing and adherence to antidiabetic medications in patients with type 2 diabetes and to examine the relationship between medication adherence and outcomes, including complication rates, medical service utilization, and workplace productivity measures.
A retrospective, cross-sectional study analyzing the healthcare experience of patients with type 2 diabetes on oral antidiabetic medication (OAD) with or without insulin (n = 96,734) and patients on OAD only (n = 55,356) with employer-sponsored insurance in the 2003-2006 MarketScan Database.
Using a 2-stage residual inclusion model, the first stage estimated the effects of cost sharing on adherence to antidiabetic medications in an 18-month time frame (January 2003 through June 2004). Adherence was determined from the percentage of days covered. The second stage estimated the effects of adherence on complication rates (eg, retinopathy, neuropathy, peripheral vascular disease), medical service utilization rates, and measures of productivity (absence days and short-term disability days) in the subsequent 2 years (July 2004 through June 2006).
A $10 increase in the patient cost-sharing index resulted in a 5.4% reduction in adherence to antidiabetic medications for patients on OAD only and a 6.2% reduction in adherence for patients on OAD with or without insulin. Adherence was associated with lower rates of complications (eg, amputation/ulcers, retinopathy) and also was associated with fewer emergency department visits and short-term disability days.
Medical plans, employers, and policy makers should consider implementing interventions targeted to improve antidiabetic medication adherence, which may translate to better outcomes.
The American journal of managed care 08/2010; 16(8):589-600. · 2.46 Impact Factor
ABSTRACT: To assess the incremental economic burden of privately insured patients with type 2 diabetes (T2DM) in 2000 and 2005 in the United States.
Adults with T2DM and 24 months of continuous health plan enrollment were identified in the MarketScan databases (2000 and 2005). Control groups of persons without diabetes were selected for comparison using propensity score matching. Total adjusted health care costs were estimated using generalized linear modeling.
Adjusted health care costs of patients with T2DM in 2005 were 136% higher than those of the matched controls ($12,733 vs $5406, P < 0.001). Similarly, costs of patients with T2DM in 2000 were 146% higher than those of the matched controls ($12,423 vs $5058, P < 0.001). Expenditures were similar for individuals with T2DM in 2000 and 2005.
T2DM continues to impose a substantial economic burden to self-insured employers.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 12/2009; 51(12):1460-5. · 1.88 Impact Factor