Back to Journals » ClinicoEconomics and Outcomes Research » Volume 6

Clinical outcomes and health care costs combining metformin with sitagliptin or sulphonylureas or thiazolidinediones in uncontrolled type 2 diabetes patients

Authors Degli Esposti L, Saragoni S, Buda S, Degli Esposti E

Received 6 March 2014

Accepted for publication 8 July 2014

Published 21 October 2014 Volume 2014:6 Pages 463—472

DOI https://doi.org/10.2147/CEOR.S63666

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Luca Degli Esposti, Stefania Saragoni, Stefano Buda, Ezio Degli Esposti

Health, Economics and Outcome Research, Clicon Srl, Ravenna, Italy


Objectives: To compare clinical outcomes and health care costs across three cohorts of uncontrolled diabetic patients who initiated treatment with one of the following: sulphonylureas (SU), thiazolidinediones (TZD) or sitagliptin (SITA).
Materials and methods: We performed a retrospective study based on a linkage between administrative and laboratory databases maintained by three Italian local health units. The index period ranged from July 2008–June 2010. Patients were treatment-naïve to either SU, TZD, or SITA, but they were already treated with other oral hypoglycemic agents. Demographics and clinical characteristics were assessed at baseline. Adherence was measured by the medication possession ratio and adherent was defined a patient with a medication possession ratio of 80% or greater. We used a Poisson regression model to estimate the risk ratios for disease-related hospitalizations that occurred during the 18-month follow-up period. The total annual costs included all the pharmacological treatments and the direct costs due to hospitalizations and outpatient services.
Results: We identified 928 patients treated with SU, 330 patients treated with TZD, and 83 patients treated with SITA. SITA patients were significantly younger and with fewer previous hospital discharges. The baseline mean glycated hemoglobin level was 8.1% for SU, 8.0% for TZD, and 8.3% for SITA patients. SITA-naïve patients resulted more adherent than the SU- and TZD-naïve patients (79.5% versus 53.2% and 62.8%, respectively; P<0.001). The SU and TZD group showed a significant increased risk of disease-related hospitalizations compared with the SITA group (the unadjusted rate was 10.42 and 7.16 per 100 person-years versus 1.64 per 100 person-years, P=0.003; compared with SU, the adjusted incidence rate ratio for SITA was 0.21, P=0.030). The total annual costs per patient were €972 for SITA, €706 for SU, and €908 for those treated with TZD.
Conclusion: Uncontrolled diabetic patients who initiated – as a second-line therapy in addition to metformin – treatment with SITA, compared to those who initiated treatment with SU or TZD, showed a reduced risk of disease-related hospitalizations. The total annual costs per patient were not significantly different among the three groups.

Keywords: diabetes, clinical practice, sitagliptin, adherence, health care costs

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Other articles by this author:

Epidemiology, patient profile, and health care resource use for hepatitis C in Italy

Sangiorgi D, Perrone V, Buda S, Boglione L, Cariti G, Lefevre C, Nappi C, Degli Esposti L

ClinicoEconomics and Outcomes Research 2017, 9:609-616

Published Date: 10 October 2017

Antithrombotic prophylaxis of atrial fibrillation in an Italian real-world setting: a retrospective study

Ermini G, Perrone V, Veronesi C, Degli Esposti L, Di Pasquale G

Vascular Health and Risk Management 2017, 13:239-246

Published Date: 5 July 2017

Healthcare resource consumption and cost of care among patients with polycystic kidney disease in Italy

Degli Esposti L, Veronesi C, Perrone V, Buda S, Santoro A

ClinicoEconomics and Outcomes Research 2017, 9:233-239

Published Date: 27 April 2017

Residual cardiovascular risk in patients who received lipid-lowering treatment in a real-life setting: retrospective study

Perrone V, Sangiorgi D, Buda S, Degli Esposti L

ClinicoEconomics and Outcomes Research 2016, 8:649-655

Published Date: 25 October 2016

Disease progression and health care resource consumption in patients affected by hepatitis C virus in real practice setting

Perrone V, Sangiorgi D, Buda S, Degli Esposti L

ClinicoEconomics and Outcomes Research 2016, 8:591-597

Published Date: 14 October 2016

Drug usage analysis and health care resources consumption in naïve patients with rheumatoid arthritis

Sangiorgi D, Benucci M, Nappi C, Perrone V, Buda S, Degli Esposti L

Biologics: Targets and Therapy 2015, 9:119-127

Published Date: 6 November 2015

Adherence to statin treatment following a myocardial infarction: an Italian population-based survey

Monaldi B, Bologna G, Costa GG, D'Agostino C, Ferrante F, Filice M, Grion A, Mingarelli A, Paloscia L, Tettamanti R, Veronesi C, Degli Esposti L

ClinicoEconomics and Outcomes Research 2015, 7:273-280

Published Date: 1 June 2015

Adherence and resource use among patients treated with biologic drugs: findings from BEETLE study

Degli Esposti L, Sangiorgi D, Perrone V, Radice S, Clementi E, Perone F, Buda S

ClinicoEconomics and Outcomes Research 2014, 6:401-407

Published Date: 18 September 2014

Drug adherence to olmesartan/amlodipine fixed combination in an Italian clinical practice setting

Degli Esposti L, Saragoni S, Buda S, Degli Esposti E

ClinicoEconomics and Outcomes Research 2014, 6:209-216

Published Date: 22 April 2014

Glycemic control and diabetes-related health care costs in type 2 diabetes; retrospective analysis based on clinical and administrative databases

Degli Esposti L, Saragoni S, Buda S, Sturani A, Degli Esposti E

ClinicoEconomics and Outcomes Research 2013, 5:193-201

Published Date: 14 May 2013

Adherence to antihypertensive medications and health outcomes among newly treated hypertensive patients

Luca Degli Esposti, Stefania Saragoni, Silvia Benemei, et al

ClinicoEconomics and Outcomes Research 2011, 3:47-54

Published Date: 7 March 2011

Antihypertensive therapy among newly treated patients: An analysis of adherence and cost of treatment over years

Luca Degli Esposti, Stefania Saragoni, Paolo Batacchi, et al

ClinicoEconomics and Outcomes Research 2010, 2:113-120

Published Date: 28 July 2010

Readers of this article also read:

Emerging and future therapies for hemophilia

Carr ME, Tortella BJ

Journal of Blood Medicine 2015, 6:245-255

Published Date: 3 September 2015

A new recombinant factor VIII: from genetics to clinical use

Santagostino E

Drug Design, Development and Therapy 2014, 8:2507-2515

Published Date: 12 December 2014

Green synthesis of water-soluble nontoxic polymeric nanocomposites containing silver nanoparticles

Prozorova GF, Pozdnyakov AS, Kuznetsova NP, Korzhova SA, Emel’yanov AI, Ermakova TG, Fadeeva TV, Sosedova LM

International Journal of Nanomedicine 2014, 9:1883-1889

Published Date: 16 April 2014

Methacrylic-based nanogels for the pH-sensitive delivery of 5-Fluorouracil in the colon

Ashwanikumar N, Kumar NA, Nair SA, Kumar GS

International Journal of Nanomedicine 2012, 7:5769-5779

Published Date: 15 November 2012

Cross-linked acrylic hydrogel for the controlled delivery of hydrophobic drugs in cancer therapy

Deepa G, Thulasidasan AK, Anto RJ, Pillai JJ, Kumar GS

International Journal of Nanomedicine 2012, 7:4077-4088

Published Date: 27 July 2012

Crystallization after intravitreal ganciclovir injection

Pitipol Choopong, Nattaporn Tesavibul, Nattawut Rodanant

Clinical Ophthalmology 2010, 4:709-711

Published Date: 14 July 2010