Document Detail

Comparison of costs and utilization between users of insulin lispro versus users of regular insulin in a managed care setting.
MedLine Citation:
PMID:  15934796     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare medical and pharmacy costs and utilization between patients with diabetes who received insulin lispro versus regular human insulin.
METHODS: A retrospective analysis of medical and pharmacy claims was conducted among continuously enrolled users of insulin lispro or regular insulin during the identification period, March 1, 2000, through February 28, 2001, within a large managed care organization. This study improved upon the methodology used in previous studies by (a) stratifying (rather than 1:1 matching) individuals by their likelihood to use insulin lispro using the propensity score binning technique, and (b) refining the study inclusion criteria to include only patients with 3 or more fills of the insulin under study (lispro or regular) to exclude individuals who may have been on either product for a short time. Because the propensity score binning technique groups patients with similar baseline characteristics within strata (bins) and not among individual patients, almost the entire available sample is retained in the analysis, unlike propensity score matching, where large numbers of patients can be excluded depending on the matching scheme. Therefore, the propensity score binning technique, because it uses more complete information, is less likely to produce biased results. Patients were grouped into 5 bins (quintiles) based on their estimated likelihood to receive insulin lispro rather than regular insulin. The propensity score model used baseline characteristics of age, gender, comorbidities, use of oral antidiabetic medications, prescription copayment, and diabetes-related costs and utilization. Overall cost and utilization differences (lispro minus regular insulin) during the 12-month follow-up period were calculated using weights inversely proportional to variances of within-bin differences.
RESULTS: Of 6,436 patients, 1,972 (30.6%) received insulin lispro and 4,464 (69.4%) received regular insulin. The propensity score estimation produced 5 bins, each containing between 1,287 and 1,288 patients, utilizing all patients in the analysis. Patients in the lower-numbered propensity score quintiles were older, more likely to use oral antidiabetic medications, and had more comorbidities than those in the higher-numbered quintiles. As quintile number increased, the percentage of insulin lispro users also increased. The weighted mean annual cost difference (lispro minus regular insulin) per patient was + USD 79 (P < 0.001) for diabetes-related pharmacy cost, + USD 212 (P < 0.001) for total pharmacy cost, USD 75 (P < 0.857) for diabetes-related medical cost, USD 2,286 (P <0.011) for nondiabetes medical cost, and USD 2,327 (P = 0.072) for total medical cost.
CONCLUSIONS: Compared with regular insulin users, insulin lispro users incurred higher diabetes-related and total pharmacy costs but lower nondiabetes medical costs and similar total medical costs. Fewer hospitalizations among insulin lispro as compared with regular insulin users contributed to lower nondiabetes medical costs and similar total medical costs.
Kristina Chen; Eunice Y Chang; Kent H Summers; Robert L Obenchain; Kristina S Yu-Isenberg; Peter Sun
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of managed care pharmacy : JMCP     Volume:  11     ISSN:  1083-4087     ISO Abbreviation:  J Manag Care Pharm     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-06-06     Completed Date:  2006-05-30     Revised Date:  2014-11-17    
Medline Journal Info:
Nlm Unique ID:  9605854     Medline TA:  J Manag Care Pharm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  376-82     Citation Subset:  IM    
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MeSH Terms
Age Factors
Drug Utilization Review / statistics & numerical data*
Follow-Up Studies
Insulin / analogs & derivatives*,  economics,  therapeutic use
Insulin Lispro
Insurance Claim Review / statistics & numerical data
Insurance, Pharmaceutical Services / economics
Managed Care Programs / economics*
Retrospective Studies
Time Factors
Reg. No./Substance:
0/Insulin; 0/Insulin Lispro

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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