Quality Measures and Healthcare Costs for Patients with Type 2 Diabetes

San Antonio—Diabetes accounted for $245 billion in total economic burden in 2012, a 41% increase from 2007. In addition to the disease, compounding factors such as glycosylated hemoglobin (A1C), body weight, and blood pressure (BP) are interrelated to the monitoring and treatment of type 2 diabetes. Marie-Hélène Lafeuille and colleagues presented a study during a poster session at the AMCP meeting, which examined the changes in selected quality measures—A1c, body weight, and BP—in patients with type 2 diabetes who have experienced inadequate glycemic control. The poster was titled Quality Measure Changes and Health Care Costs in Patients With Type 2 Diabetes Mellitus With Inadequate Glycemic Control: Economic Simulation of Canagliflozin and Sitagliptin Treatment Outcomes.

The patients in this study were being treated with metformin and sulfonylurea for their diabetes. An assessment of the association of the changes in HbA1c, body weight, and BP in terms of healthcare costs was compiled. Health insurance claims and electronic medical records were taken from the Reliant Medical Group between January 1, 2007, and December 31, 2011. Data collected during the 5-year study period included enrollment records and patient demographics, medical and pharmacy claims, laboratory results, and clinical measures.

Patients met the study inclusion criteria if they had ≥1 diagnosis for type 2 diabetes; inadequate glycemic control event with an A1C between 7% and 10.5% at the index date after ≥6 months of continuous eligibility while being treated with metformin and sulfonylurea (eg, chlorpropamide, glimepiride, glipizide, glyburide, tolazamide, tolbutamide); ≥12 months of continuous eligibility after the index date; and ≥18 years of age. 

This study assessed the difference in healthcare costs per-patient per-year between the landmark period and the 12 months following. Healthcare costs were stratified into all-cause and diabetes-related medical costs and pharmacy costs. There were 2 models of this study—model 1 controlled only for the quality measures, while model 2 included characteristics such as age, gender, ethnicity, payer type, year of index, and Charlson comorbidity index as controls. In the model that controlled for baseline characteristics, an increase of 1% in HbA1c was associated with an increase in total healthcare costs—both medical and pharmacy—for a total of $4493 (P=.024). An increase in body weight, systolic BP, and diastolic BP was associated with a cost increase of $239 (P=.481), a cost increase of $562 (P=.006), and a cost decrease of $361 (P=.07), respectively. The results from model 1 indicated that canagliflozin and sitagliptin treatments resulted in a reduction in yearly healthcare costs of $6439 (95% confidence interval [CI]=-12,750; -909; P=.02) and $2405 (95% CI; -5036; P=.062), respectively.

The results from model 2 showed that changes in the quality measures provided results equivalent to previously reported changes associated with canagliflozin and sitagliptin treatments, where they were associated with a reduction in healthcare costs of $6265 (95% CI=-12,865; -681; P=.03) and $2309 (95% CI=-5073; 177; P=.072), respectively. The largest contributor to the reduction in costs was the decrease in patients’ HbA1c. Decreases in diabetes-related medical and pharmacy costs played a role in the overall cost reductions for both canagliflozin (-$2978 [95% CI=-5628; -728; P=.008) and sitagliptin (-$843 [95% CI=-2151; 335; P=.017).

The researchers concluded that an integrated approach of medications for disease management may be successful at reducing downstream healthcare costs.

This study was supported by Janssen Scientific Affairs, LLC.