Clinical and economic outcomes among injection-naïve patients with type 2 diabetes initiating dulaglutide compared with basal insulin in a US real-world setting: the DISPEL Study

Dec 26, 2019BMJ open diabetes research & care

Health and cost outcomes for people with type 2 diabetes starting dulaglutide versus basal insulin in US real-world care

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Abstract

At 1 year, dulaglutide patients showed a 1.12% reduction in hemoglobin A1c compared to a 0.51% reduction for basal insulin.

Dulaglutide is associated with significantly greater reductions in hemoglobin A1c compared to basal insulin.
Medical costs for patients using dulaglutide were lower than those for basal insulin, amounting to $3753 versus $7604.
Pharmacy costs were higher for dulaglutide users at $9809 compared to $6175 for basal insulin.
Total diabetes-related costs were similar for both treatments, with dulaglutide costing $13,562 and basal insulin $13,779.
Cost per 1% reduction in hemoglobin A1c was lower for dulaglutide in both medical ($3128 vs $12,673) and total costs ($11,302 vs $22,965).

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AIMS: To report 1-year clinical and economic outcomes from the retrospective DISPEL (Dulaglutide vs Basal InSulin in Injection Naïve Patients with Type 2 Diabetes: Effectiveness in ReaL World) Study.

MATERIALS AND METHODS: This observational claims study included patients with type 2 diabetes (T2D) and ≥1 claim for dulaglutide or basal insulin between November 2014 and April 2017 (index date=earliest fill date). Propensity score matching was used to address treatment selection bias. Change from baseline in hemoglobin A1c (HbA1c) was compared between the matched cohorts using analysis of covariance; diabetes-related costs were analyzed using generalized linear models.

RESULTS: Matched cohorts (903 pairs total; 523 pairs with complete cost data) were balanced in baseline characteristics with mean HbA1c 8.6%, mean age 54 years. At 1 year postindex, dulaglutide patients had significantly greater reduction in HbA1c than basal insulin (-1.12% vs -0.51%, p<0.01), lower medical costs ($3753 vs $7604, p<0.01), higher pharmacy costs ($9809 vs $6175, p<0.01), and similar total costs ($13 562 vs $13 779, p=0.76). Medical and total costs per 1% HbA1c reduction were lower for dulaglutide than basal insulin (medical: $3128 vs $12 673, p<0.01; total: $11 302 vs $22 965, p<0.01), while pharmacy costs per 1% HbA1c reduction were lower without reaching statistical significance ($8174 vs $10 292, p=0.15).

CONCLUSIONS: In this real-world study, patients with T2D initiating dulaglutide demonstrated greater HbA1c reduction compared with those initiating basal insulin. Although total diabetes-related costs were similar, the total diabetes-related costs per HbA1c reduction were lower for dulaglutide, highlighting the importance of evaluating effectiveness along with the economic impact of medications.

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Clinical and economic outcomes among injection-naïve patients with type 2 diabetes initiating dulaglutide compared with basal insulin in a US real-world setting: the DISPEL Study

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