Insulin Adherence Associated With Lower All-Cause Health Care Costs

Patients adherent to new basal insulin (BAS) or basal-bolus (BAS-BOL) combination regimens for type 2 diabetes management had significantly lower all-cause total healthcare costs despite significantly higher drug costs compared with nonadherent patients, according to a study published in the Journal of Managed Care & Specialty Pharmacy. 

“In particular, adherent patients had substantially lower all-cause and diabetes-related acute care costs, suggesting fewer or less severe episodes of hospitalization or emergency room visits,” wrote researchers from Eli Lilly and Company and HealthMetrics Outcomes Research. “These findings suggest that adherence to either a BAS or BAS-BOL regimen may be associated with lower overall costs for payers during the first year of initiation of these regimens.” 

The study used data from a US retrospective claims database to identify 13,296 adults who initiated BAS therapy and 10,069 adults who initiated BAS-BOL therapy for type 2 diabetes. To determine insulin adherence, defined as having proportion of days covered of at least 80%, researchers followed patients for 1 year.

Among patients who initiated BAS therapy, 5502 were adherent, and 7794 were nonadherent, according to the study. Among those who initiated BAS-BOL therapy, 2006 were adherent, and 8063 were nonadherent. 

In both therapy cohorts, adherent patients had significantly lower all-cause total unadjusted costs compared with nonadherent patients: $29,322 compared with $31,888 among those on BAS therapy, and $36,229 compared with $40,147 among those on BAS-BOL combination therapy. Researchers found that drug costs were behind 39.5% to 45.4% of costs for adherent patients, compared with 23% to 25.9% of costs for nonadherent patients.  

Adjusted all-cause total costs, too, were significantly lower for adherent patients than nonadherent patients. In the BAS cohort, the study identified adjusted all-cause total costs of $30,127 for adherent patients compared with $37,049 for nonadherent patients. In the BAS-BOL cohort, adjusted all-cause total costs were $36,603 for adherent patients compared with $44,702 for nonadherent patients. 

“As such, study findings are consistent with previous research, which has found that patients who are adherent to glucose-lowering agents generally have better health outcomes, including less hospitalization and emergency room use, complications, and short-term disability days,” researchers wrote. “In addition, these study findings are in concert with research that has reported an association between adherence to BAS therapy and better patient outcomes.”

—Jolynn Tumolo 

Reference 

Eby EL, Bajpai S, Faries DE, Haynes VS, Lage MJ. The Association Between Adherence to Insulin Therapy and Health Care Costs for Adults with Type 2 Diabetes: Evidence from a U.S. Retrospective Claims Database. J Manag Care Spec Pharm. 2020;26(9):1081-1089. doi:10.18553/jmcp.2020.26.9.1081