Healthcare utilization changes in relation to treatment intensification with insulin aspart in patients with type 2 diabetes. Data from a large US managed-care organization

Figures & data

Table 1. Patient characteristics at the index date.

Characteristics	Patients initiating insulin aspart (n =1,739)
Mean age (years)	56
Female/male (%)	45/55
Mean pre-index HbA1c (%)	8.8
Basal insulin regimen (%):
NPH insulin	6.96
Insulin glargine	81.66
Insulin detemir	11.39
Region (%):
Northeast	7.5
South	47
Midwest	33.5
West	12
Pre-index oral medication use (%):
Thiazolidinedione	23
Sulfonylurea	25
Metformin	40
OAD combination	9
Other	18

HbA1c, glycosylated hemoglobin.

Table 2. Overall and diabetes-related healthcare costs during the pre- and post-index date periods (costs are per patient per year).

Costs	Pre-index costs	Post-index costs	Change in costs
Overall healthcare costs ($)
Total costs	44,304 (109,867)	42,021 (78,849)	–2,283 (99,608)***
Medical costs	37,277 (108,172)	33,606 (76,849)	–3,670 (99,386)
Pharmacy costs	7,027 (7,460)	8,414 (7,961)	1,387 (5,093)***
Diabetes-related healthcare costs ($)
Total costs	16,276 (44,007)	14,248 (27,657)	–2,028 (46,950)**
Medical costs	13,642 (44,049)	11,131 (27,496)	–2,511 (46,864)
Pharmacy costs	2,634 (1,857)	3,117 (2,108)	483 (1,887)***
Insulin costs	1,670 (1,252)	2,448 (1,715)	777 (1,652)***
Non-insulin costs	964 (1,276)	670 (1,035)	–294 (1,010)***

Data are mean (SD); ***p≤0.0001, **p< 0.001.

Table 3. Number and proportion of patients on concomitant medication during the pre- and post-index date periods.

Medication	Patients on concomitant medication, n (%)
	Pre-index	Post-index
Total	1,110 (64)	976 (56)***
Thiazolidinedione	406 (23)	238 (14)***
Sulfonylurea	438 (25)	241 (14)***
Metformin	698 (40)	617 (35)***
OAD combination	152 (9)	91 (5)***
Other	308 (18)	193 (11)***

OAD, oral antidiabetic drug; OAD combination, OAD consisting of more than one active substance; ***p< 0.0001 post-index vs. pre-index.

Table 4. Mean healthcare resource utilization and costs during the pre- and post-index date periods.

	Healthcare resource utilization (visits/patient/year)			Healthcare resource costs ($/patient/year)
	Pre-index	Post-index	Change	Pre-index	Post-index	Change
Overall resources
Office visits	15.70 (14.56)	15.56 (13.95)	–0.14 (13.83)	4,659 (11,045)	4,602 (7,622)	–57 (9,285)*
Outpatient visits	6.36 (11.14)	6.36 (11.55)	0.00 (11.80)	9,423 (36,301)	11,212 (36,683)	1,789 (32,616)**
ER visits	0.66 (3.64)	0.67 (3.35)	0.01 (3.57)	191 (1,341)	159 (932)	–32 (1,474)
Inpatient visits	7.20 (29.32)	5.34 (19.28)	–1.86 (30.79)*	20,393 (91,354)	14,057 (50,675)	–6,336 (93,782)
Other services	5.11 (7.63)	5.70 (9.60)	0.59 (8.63)	2,610 (7,277)	3,568 (12,171)	958 (12,305)*
Total						–3,678
Diabetes-related resources
Office visits	6.59 (5.29)	5.81 (4.66)	–0.77 (5.13)***	1,241 (1,386)	1,155 (1,362)	–86 (1,591)***
Outpatient visits	1.67 (3.90)	1.57 (3.84)	–0.10 (4.18)	2,744 (9,989)	3,144 (9,695)	400 (12,427)*
ER visits	0.09 (0.72)	0.06 (0.41)	–0.03 (0.66)	67 (668)	47 (552)	–20 (806)
Inpatient visits	2.19 (7.60)	1.70 (7.08)	–0.50 (8.85)*	8,881 (41,669)	5,862 (23,489)	–3,019 (44,412)
Other services	1.83 (3.00)	1.86 (3.35)	0.04 (3.55)	709 (2,248)	922 (3,058)	214 (3,538)
Total						–2,511

Data are mean (SD); ***p≤0.0001, **p< 0.001, *p< 0.05. ER, emergency room.

Figure 1. Cost distribution. The proportion of cost associated with emergency room (ER) visits was 0% before and after initiation of insulin aspart.