Saxagliptin Less Costly in Specific Patient Populations

San Diego—Diabetes patients treated with saxagliptin were significantly less prone to inpatient hospitalizations or emergency department (ED) visits than patients treated with sulfonylureas. Total healthcare costs were also lower for the saxagliptin group. Study data were presented during a poster session at the AMCP meeting. The poster was titled Healthcare Resource Use and Cost Outcomes with Saxagliptin versus Sulfonylureas in Elderly and Renally Impaired Patients.

Treatment options for type 2 diabetes include various classes of drugs, however, renally impaired and elderly patients, at risk for hypoglycemia, are often more limited in their options. Because saxagliptin is a clinically appropriate option for elderly and renally impaired patients, an assessment of healthcare resource use and costs among these subgroups may provide value for healthcare decision makers treating this patient population.

Using retrospective claims data from the Truven Health Analytics MarketScan^® database from 2009 to 2011, researchers compared healthcare resource use and cost outcomes among type 2 diabetes patients during a 6-month period following treatment initiation with saxagliptin or sulfonylureas. The researchers also assessed the outcomes among a subset of patients with renal impairment and patients ≥65 and ≥75 years of age.

Patients eligible for inclusion in the study cohorts for saxagliptin and sulfonylureas included adults diagnosed with type 2 diabetes in 2009 or later, patients with at least 1 prescription drug claim for either medication, and patients with no prior use of saxagliptin or a sulfonylurea 6 months before initiation of drug therapy. All-cause and diabetes-related medical resource use was reported by place of service (inpatient stays, ED visits, and other medical visits). Healthcare expenditures were based on reimbursements from private insurers to healthcare providers for medical services and prescription drugs.

The overall analysis included 13,929 patients treated with saxagliptin and 117,756 patients treated with a sulfonylurea. The subgroup analyses included 36,959 patients ≥65 years of age (n=3355 saxagliptin and n=33,604 sulfonylurea); 16,997 patients ≥75 years of age (n=1419 saxagliptin and n=15,578 sulfonylurea); and 15,337 patients with renal impairment (n=1484 saxagliptin and n=13,853 sulfonylurea).

The results found that a smaller group of saxagliptin patients had at least 1 all-cause or diabetes-related inpatient stay, ED visit, or other medical visit, but the proportions of saxagliptin patients with all-cause and diabetes-related outpatient visits were higher than sulfonylurea patients (95.5% and 80.2% vs 93.6% and 76.3%, respectively). Among patients ≥65 and ≥75 years of age, data showed that smaller proportions of saxagliptin patients had all-cause and diabetes-related resource use, with the exception of outpatient visits.

For patients with renal impairment, the results showed that smaller proportions of saxagliptin patients had all-cause and diabetes-related inpatient and ED visits than sulfonylurea patients. In this subgroup, more saxagliptin patients had all-cause and diabetes-related outpatient visits than sulfonylurea patients (98.2% and 84.8% vs 96.9% and 78.2%, respectively).

Total healthcare costs during the study period were $554 lower for saxagliptin patients than sulfonylurea patients ($7346 vs $7900, respectively; P<.001). The results of the subgroup analyses of patients ≥65 and ≥75 years of age revealed statistically similar findings to the overall analysis. Further, the results of patients with renal impairment were also similar, but cost levels were greater than costs for the overall sample ($10,638 vs $15,371, respectively; P<.001).

The investigators noted study limitations including that the study relied on the accuracy of diagnosis coding in claims data. Because all patients in the database were privately insured, the study results may not have been nationally representative.

This study was supported by Bristol-Myers Squibb and AstraZeneca.