Retrospective study comparing healthcare costs and utilization between commercially insured patients with type 2 diabetes mellitus who are newly initiating exenatide once weekly or liraglutide in the United States

Figures & data

Table 1. Patient demographics.

	Exenatide QW	Liraglutide (all)	Liraglutide 1.2 mg	Liraglutide 1.8 mg
	n = 2445	n = 9106	n = 4188	n = 4918
Age in years, mean (SD)	52.1 (8.3)	51.9 (8.2)	52.1 (8.1)	51.8 (8.3)
Female, %	50.5	54.8*	55.7*	53.9*
Geographic region, %
Northeast	10.2	12.6*	12.5*	12.7*
North Central	23.3	20.6	22.0	19.3
South	50.8	53.4	52.3	54.4
West	14.2	11.6	11.7	11.4
Unknown	1.6	1.8	1.3	2.3
Health plan type, %
Basic/major medical	1.2	2.3*	2.2*	2.4*
Comprehensive	1.0	0.8	0.8	0.8
EPO	12.8	11.0	11.2	10.9
HMO	8.8	8.1	8.3	8.0
POS	63.5	65.0	64.3	65.6
PPO	0.3	0.5	0.3	0.6
POS w/capitation	7.2	6.5	6.6	6.4
CDHP/HDHP	5.2	5.7	6.3	5.3

*P < 0.05 for exenatide QW vs. comparators.

*Statistical significance for groups of rows in which categorical variables are reported is included in top row only.

CDHP = consumer-directed health plan; EPO = exclusive provider organization; HDHP = high-deductible health plan; HMO = health maintenance organization; POS = point of service; PPO = preferred provider organization; QW = once weekly; SD = standard deviation.

Table 2. Patient baseline clinical characteristics.

	Exenatide QW	Liraglutide (all)	Liraglutide 1.2 mg	Liraglutide 1.8 mg
	n = 2445	n = 9106	n = 4188	n = 4918
Comorbid conditions, %
Microvascular complications of diabetes†	19.5	16.1*	15.3*	16.7*
Cardiovascular disease‡	14.1	12.1*	11.5*	12.7
Dyslipidemia	80.9	78.4*	78.7*	78.1*
Hypertension	83.5	82.9	83.5	82.4
Hypoglycemia	3.6	2.7*	2.3*	2.9
Obesity	18.5	17.5	16.2*	18.6
Renal impairment	4.9	5.1	4.8	5.4
Deyo–Charlson Comorbidity Index, mean (SD)	1.7 (1.2)	1.6 (1.2)	1.6 (1.2)	1.6 (1.2)
3 digit ICD-9-CM diagnosis codes, mean (SD)	11.2 (7.5)	10.9 (7.5)	10.7 (7.3)	11.1 (7.6)
Unique NDCs, mean (SD)	15.0 (8.2)	14.5 (8.1)	14.4 (8.0)	14.6 (8.3)
Total healthcare costs, mean (SD)	$13,162 ($17,968)	$12,299 ($20,264)	$11,813 ($20,112)*	$12,712 ($20,385)
Overall inpatient admission, %	7.6	8.0	7.5	8.5
Diabetes-specific inpatient admission, %	5.0	5.5	4.8	6.2
OOP cost for index GLP-1RA$, mean (SD)	$55 ($48)	$49 ($47)*	$46 ($39)*	$51 ($54)*
Endocrinologist visit, %	33.2	20.9*	16.5*	24.7*
Index GLP-1RA prescription fill source, %
Retail	82.5	81.1	78.4*	83.4
Mail order	14.1	14.6	16.5	13.1
Retail and mail order¶	0.1	0.2	0.3	0.1
Missing	3.4	4.0	4.8	3.4

*P < 0.05 for exenatide QW vs. comparators.

*Statistical significance for groups of rows in which categorical variables are reported is included in top row only.

†Microvascular complications of diabetes included diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy.

‡Cardiovascular disease included atherosclerosis, stroke, myocardial infarction, unstable angina pectoris, heart failure, percutaneous coronary intervention, and coronary artery bypass graft.

$OOP cost for index GLP-1RA expressed in monthly units and measured during 6 month follow-up period.

¶Index GLP-1RA prescription fill source = retail and mail order indicates that patient had more than one prescription fill source for the index GLP-1RA on the index date.

GLP-1RA = glucagon-like peptide-1 receptor agonist; ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification; NDC = National Drug Code; OOP = out-of-pocket; QW = once weekly; SD = standard deviation.

Figure 1. Patient selection diagram. BID = twice daily; GLP-1RA = glucagon-like peptide-1 receptor agonist; QW = once weekly.

Table 3. Unadjusted overall healthcare utilization during 6 month follow-up period.

Healthcare utilization, %	Exenatide QW	Liraglutide (all)	Liraglutide 1.2 mg	Liraglutide 1.8 mg
	n = 2445	n = 9106	n = 4188	n = 4918
Inpatient admission	4.3	5.1	5.4*	4.9
Emergency room visit	13.2	13.5	13.6	13.4
Outpatient office visit	95.9	95.8	95.8	95.8
Other outpatient services	96.1	94.7*	94.3*	94.9*

*P < 0.05 for exenatide QW vs. comparators.

QW = once weekly.

Table 4. Unadjusted overall healthcare costs during 6 month follow-up period.

Healthcare costs, mean (SD)	Exenatide QW	Liraglutide (all)	Liraglutide 1.2 mg	Liraglutide 1.8 mg
	n = 2445	n = 9106	n = 4188	n = 4918
Total costs	$8399 ($15,101)	$8281 ($14,328)	$7942 ($13,093)	$8570 ($15,297)
Payer-paid total costs	$7332 ($14,783)	$7260 ($13,915)	$6934 ($12,616)	$7537 ($14,928)
Patient-paid total costs	$1067 ($895)	$1021* ($1001)	$1008* ($1066)	$1033 ($943)
Total medical costs (non-pharmacy)	$4318 ($14,491)	$4528 ($13,797)	$4508 ($12,424)	$4545 ($14,869)
Inpatient admission	$1155 ($11,927)	$1480 ($10,877)	$1540 ($9186)	$1429 ($12,133)
Emergency room visit	$165 ($662)	$168 ($960)	$163 ($1052)	$172 ($873)
Outpatient office visit	$459 ($399)	$440 ($373)*	$433 ($373)*	$447 ($373)
Other outpatient service	$2540 ($6427)	$2439 ($6601)	$2372 ($6076)	$2497 ($7017)
Total pharmacy costs	$4081 ($2985)	$3753* ($2985)	$3434* ($3031)	$4025 ($2917)

*P < 0.05 for exenatide QW vs. comparators.

SD = standard deviation; QW = once weekly.

Figure 2. Multivariable logistic regression-adjusted odds of overall inpatient admission during 6 month follow-up period, exenatide QW as reference category (N = 11,551). CI = confidence interval; QW = once weekly.

Figure 3. Multivariable regression-adjusted overall total healthcare costs during 6 month follow-up period (N = 11,551). QW = once weekly.

Figure 4. Multivariable regression-adjusted overall medical costs during 6 month follow-up period (N = 11,551). QW = once weekly.

Table 5. Unadjusted diabetes-specific healthcare utilization during 6 month follow-up period.

Healthcare utilization, %	Exenatide QW	Liraglutide (all)	Liraglutide 1.2 mg	Liraglutide 1.8 mg
	n = 2445	n = 9106	n = 4188	n = 4918
Inpatient admission	2.7	3.5*	3.5	3.4
Emergency room visit	5.4	5.7	6.1	5.4
Outpatient office visit	84.5	84.6	83.7	85.4
Other outpatient services	83.6	82.2	81.1*	83.1

*P < 0.05 for exenatide QW vs. comparators.

QW = once weekly.

Table 6. Unadjusted diabetes-specific healthcare costs during 6 month follow-up period.

Healthcare costs (mean, SD)	Exenatide QW	Liraglutide (all)	Liraglutide 1.2 mg	Liraglutide 1.8 mg
	n = 2445	n = 9106	n = 4188	n = 4918
Total costs	$3761 ($6955)	$3699 ($5922)	$3350* ($5661)	$3997 ($6119)
Payer-paid total costs	$3287 ($6864)	$3271 ($5741)	$2939* ($5506)	$3554 ($5920)
Patient-paid total costs	$474 ($447)	$428* ($458)	$411* ($425)	$443* ($484)
Total medical costs (non-pharmacy)	$1252 ($6767)	$1387 ($5716)	$1367 ($5479)	$1403 ($5911)
Inpatient admission	$481 ($6112)	$590 ($4830)	$608 ($4724)	$575 ($4919)
Emergency room visit	$53 ($331)	$60 ($606)	$67 ($804)	$54 ($361)
Outpatient office visit	$205 ($187)	$203 ($185)	$197 ($181)	$208 ($188)
Other outpatient service	$513 ($2232)	$534 ($2581)	$496 ($2016)	$566 ($2979)
Total pharmacy costs	$2509 ($1456)	$2313* ($1489)	$1983* ($1349)	$2594* ($1545)

*P < 0.05 for exenatide QW vs. comparators.

SD = standard deviation; QW = once weekly.

Figure 5. Multivariable logistic regression-adjusted odds of diabetes-specific inpatient admission during 6 month follow-up period, exenatide QW as reference category (N = 11,551). CI = confidence interval; QW = once weekly.

Figure 6. Multivariable regression-adjusted diabetes-specific total costs during 6 month follow-up period (N = 11,551). QW = once weekly.

Figure 7. Multivariable regression-adjusted diabetes-specific medical costs during 6 month follow-up period (N = 11,551). QW = once weekly.

Figure 8. Multivariable regression-adjusted GLP-1RA costs during 6 month follow-up period (N = 11,551). GLP-1RA = glucagon-like peptide-1 receptor agonist; QW = once weekly.