Pens versus Vials for Insulin Delivery: A Cost Comparison

San Francisco—Diabetes mellitus (DM) is the leading cause of kidney failure, nontrauma-related amputation of lower limbs, and new cases of blindness in the United States; it is also one of the most common causes of heart disease, stroke, and death. Type 2 DM (T2DM) is the most common form of the disease, affecting up to 7.9% of the US population. Estimated associated healthcare costs are $159.5 billion each year.

Treatment guidelines emphasize the correct type of insulin at the correct time; according to researchers, the method used to deliver the insulin may also have an impact on patient outcomes. Previous studies have shown that patients prefer using an insulin pen rather than the traditional syringe and vial.

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Researchers recently conducted a retrospective analysis to compare total direct healthcare charges and diabetes-related total direct healthcare charges among adults with T2DM who initiate therapy with mealtime insulin disposable pens or vials. They reported results of the analysis at a poster session at the AMCP meeting. The poster was titled The Association Between Use of Mealtime Insulin Pens versus Vials and Healthcare Charges in Patients with Type 2 Diabetes.

The analysis compared the insurance claims of a nationwide sample of adults who initiated mealtime analog insulin therapy with a prefilled pen or conventional syringe and vial to assess the impact of the delivery method on both patient total direct healthcare costs and diabetes-related total direct healthcare costs. Key components of total charges and total diabetes-related charges were also studied.

Data from the Innovus InVision™ DataMart database from January 1, 2006, through June 30, 2010, were used in the study. After applying inclusion and exclusion criteria, the analysis included data on 4429 patients using prefilled pens and 3945 patients using syringes and vials.

Total direct healthcare charges were measured as the submitted charges less any not covered expenses due to ineligible charges, ineligible patients or providers, or incomplete information. Total direct diabetes-related healthcare charges were measured as all charges with an accompanying diagnosis of T2DM, use of an antidiabetic medication, or use of diabetic supplies.

Charges were divided into inpatient, outpatient, emergency department (ED), and drug costs.

There were significant differences between the 2 groups in age, area of residence, type of insurance coverage, prescribing physician, amount of copayment, priori hospitalization, number of medications prescribed, and Charlson Comorbidity Index score (P<.001 for all comparisons). The use of pens, compared with syringes/vials, was associated with significantly lower total inpatient charges ($11,960 vs $19,922; P<.05) and total outpatient charges ($20,746 vs $25,667; P<.05); however, total drug charges were significantly higher with pens compared with vials ($8695 vs $8300; P<.05). There was no difference between the 2 groups in total ED charges.

The use of pens, compared with syringes/vials, was associated with significantly lower total diabetes-related inpatient charges ($4352 vs $6451; P<.05) and total diabetes-related outpatient charges ($4660 vs $5340; P<.05); total diabetes-related charges were significantly higher with pens compared with vials ($3593 vs $2755; P<.05). There was no difference between the 2 groups in ED diabetes-related charges.

Finally, the total healthcare charges and total diabetes-related healthcare charges were significantly lower for the group using pens compared with the group using syringes/vials: total healthcare charges, $42,150 vs $53,340; total diabetes-related healthcare care charges, $12,722 vs $14,540; P<.05) despite the higher drugs charges.

In conclusion, the authors summarized that “those whose insulin was delivered via pens versus syring/vials had significantly lower total direct healthcare charges as well as significantly lower total direct diabetes-related healthcare charges.” They added that, “future research is needed to explore the impacts of pen versus traditional syringe and vial use.”—Tori Socha

This study was supported by Eli Lilly and Company.