Within-Trial Evaluation of Medical Resources, Costs, and Quality of Life Among Patients With Type 2 Diabetes Participating in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL)
| Autor: | Eric Wittbrodt, Kartman B, M A Bethel, Neha J. Pagidipati, Adrian F. Hernandez, Shelby D. Reed, Helen Dakin, Jose Leal, Robert J. Mentz, Rury R. Holman, Alastair Gray, Frauke Becker, Yanhong Li, Stephanie M. Gustavson |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Research design medicine.medical_specialty Total cost Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism Type 2 diabetes Medicare Rate ratio Placebo 03 medical and health sciences 0302 clinical medicine Quality of life Cause of Death Diabetes mellitus Internal Medicine medicine Humans Hypoglycemic Agents 030212 general & internal medicine Epidemiology/Health Services Research health care economics and organizations Aged Aged 80 and over Advanced and Specialized Nursing business.industry Incidence Health Care Costs Middle Aged medicine.disease United Kingdom United States Intention to Treat Analysis Hospitalization Diabetes Mellitus Type 2 Cardiovascular Diseases Emergency medicine Quality of Life Exenatide Health Resources Female business Diabetic Angiopathies Follow-Up Studies medicine.drug |
| Zdroj: | Diabetes Care |
| ISSN: | 1935-5548 0149-5992 |
| DOI: | 10.2337/dc19-0950 |
| Popis: | OBJECTIVE To compare medical resource use, costs, and health utilities for 14,752 patients with type 2 diabetes who were randomized to once-weekly exenatide (EQW) or placebo in addition to usual diabetes care in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL). RESEARCH DESIGN AND METHODS Medical resource use data and responses to the EuroQol 5-Dimension (EQ-5D) instrument were collected at baseline and throughout the trial. Medical resources and medications were assigned values by using U.S. Medicare payments and wholesale acquisition costs, respectively. Secondary analyses used English costs. RESULTS Patients were followed for an average of 3.3 years, during which time those randomized to EQW experienced 0.41 fewer inpatient days (7.05 vs. 7.46 days; relative rate ratio 0.91; P = 0.05). Rates of outpatient medical visits were similar, as were total inpatient and outpatient costs. Mean costs for nonstudy diabetes medications over the study period were ∼$1,600 lower with EQW than with placebo (P = 0.01). Total within-study costs, excluding study medication, were lower in the EQW arm than in the placebo arm ($28,907 vs. $30,914; P ≤ 0.01). When including the estimated cost of EQW, total mean costs were significantly higher in the EQW group than in the placebo group ($42,697 vs. $30,914; P < 0.01). With English costs applied, mean total costs, including exenatide costs, were £1,670 higher in the EQW group than the placebo group (£10,874 vs. £9,204; P < 0.01). There were no significant differences in EQ-5D health utilities between arms over time. CONCLUSIONS Medical costs were lower in the EQW arm than the placebo arm, but total costs were significantly higher once the cost of branded exenatide was incorporated. |
| Databáze: | OpenAIRE |
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