Pdb57 real-world economic outcomes among patients with type 2 diabetes (t2d) treated with dulaglutide (du) vs. basal insulin (bi) in the us: the dispeltm study

To report 1-year economic outcomes from the retrospective Dulaglutide vs. Basal InSulin in Injection Naïve Patients with Type 2 Diabetes: Effectiveness in ReaL World (DISPEL) study. The HealthCore Integrated Research Database (HIRD®) was used to identify patients with T2D initiating DU or BI between 11/01/2014 and 04/30/2017 (index date=earliest fill date). Patients ≥18 years, with no claim for any antidiabetic injectable in the 6 months pre-index period (baseline), continuous enrollment and ≥1 HbA1c result at baseline and 1-year post-index were included. DU initiators were propensity-matched 1:1 to BI initiators. Mean diabetes-related medical, pharmacy and total healthcare costs during the 1-year post-index period were compared between the matched cohorts using generalized linear models. Mean costs per 1% HbA1c reduction were compared using bootstrap. Costs were adjusted to 2017 US dollars. The matched cohorts with 523 DU:BI pairs were well-balanced on baseline characteristics including healthcare costs. Mean age was 54 years and approximately 51% were males. At 1-year post-index, DU initiators had higher diabetes-related pharmacy costs (mean±SD: $9,809±$5,235 vs. $6,175±$5,231, p<0.01), lower diabetes-related medical costs ($3,753±$9,111 vs. $7,604±$24,234, p<0.01) and similar diabetes-related total costs ($13,562±$10,261 vs. $13,779±$24,728, p=0.76) compared to BI initiators. DU initiators achieved greater HbA1c reduction [-1.2 (1.53) vs. -0.6 (1.85), p<0.01]. The mean (±bootstrap SE) diabetes-related medical and total costs per 1% HbA1c reduction were lower for DU initiators than BI initiators (medical: $3,128±$399 vs. $12,673±$2,825, p<0.01; total: $11,302±$752 vs. $22,965±$4,125, p<0.01), while pharmacy costs per 1% HbA1c reduction were lower without reaching statistical significance ($8,174±$504 vs. $10,292 ±$1,768, p=0.15). Although there was no significant difference in the total diabetes-related cost between the two cohorts at 1-year follow up, the total cost per HbA1c reduction was lower for DU vs. BI initiators, highlighting the importance of evaluating effectiveness along with the economic impact of medications.