Comparison of Diabetes Treatment with DPP-4 Inhibitor or Sulfonylurea

Tampa—Diabetes is associated with a sizeable national economic burden. In 2012 dollars, the burden of diagnosed cases in the United States was estimated at $245 billion. Patients with type 2 diabetes mellitus (T2DM)—accounting for 90% to 95% of all diabetes cases—may receive a dipeptidyl peptidase-4 (DPP-4) inhibitor or sulfonylurea.

According to the results of a recent study, patients initiating DPP-4 inhibitor treatment reported lower overall charges and hospitalization rates and higher pharmacy charges when compared to patients initiating sulfonylurea.

The results of this study were presented at the AMCP meeting during a poster presentation titled Charges and Healthcare Resource Use in Patients With Type 2 Diabetes Mellitus After Initiating a Dipeptidyl Peptidase-4 Inhibitor or Sulfonylurea.

John J. Sheehan, PhD, RPh, and colleagues conducted a retrospective, cohort study using data from a US insurance claims dataset for patients newly initiating treatment with a DPP-4 inhibitor or sulfonylurea between January 1, 2010, and December 31, 2011. Patients were eligible for the study if they were ≥18 years of age diagnosed with T2DM, had at least 1 prescription claim for a DPP-4 inhibitor or sulfonylurea during the study period, had a least 6 months of continuous eligibility before treatment initiation at baseline, and had at least 6 months of continuous eligibility after treatment initiation during follow-up.

The study examined overall and diabetes-specific charges in the 6-month follow-up period. Breakdowns of pharmacy, medical, and overall charges were compared using a generalized linear model to estimate treatment effect on charges. Hospitalization rates were also compared.

The study population consisted of 23,077 patients with T2DM who initiated treatment with a DPP-4 inhibitor and 46,428 patients with T2DM who initiated treatment with sulfonylurea.

After adjusting for overall charges, DPP-4 inhibitor treatment during the 6-month follow-up period was significantly lower than sulfonylurea ($12,241 vs $12,544; P=.0131). Overall medical charges were also lower with DPP-4 inhibitor treatment ($8961 vs $10,240; P<.0001); however, overall pharmacy charges were lower with sulfonylurea treatment ($2998 vs $2071).

DPP-4 inhibitor treatment was associated with significantly higher diabetes-related charges ($4772 vs $4437) and significantly higher diabetes-related pharmacy charges ($1364 vs $499; P<.0001). However, diabetes-related pharmacy charges were lower for DPP-4 inhibitors ($3247 vs $3802; P<.0001).

In terms of all-cause and diabetes-related hospitalizations, inpatient rates were significantly lower with DPP-4 inhibitors (P<.0001).

The study authors noted limitations; because this was not a randomized study, differences between groups may be due to underlying differences in the patient populations, and laboratory measures were not included as outcome measures because of unavailability of laboratory values.

The study authors noted that these finding may help payers when managing patients with T2DM.

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