Switch To Insulin Pen Improves Clinical Outcomes And Reduces Medical Costs

Total all-cause annual treatment costs reduced by $1590 per patient. Won Chan Lee, Ph.D., Abt Associates’ Director of Health Economics, recently led a first of its kind study to evaluate the clinical and economic effects of the conversion from conventional vial and syringe delivery to an insulin analogue pen device in patients with type 2 diabetes. The results, show that switching to an insulin pen led to improved medication adherence, fewer claims for hypoglycemic events, reduced emergency department and physician visits, and, ultimately, lower treatment costs.

Pen devices which combine the insulin cartridge and syringe in a single unit have been reported to improve dosing accuracy, increase mealtime flexibility and convenience of insulin delivery, with resulting positive effects on patient preference and treatment. Additional advantages of pre-filled insulin pens include improved user confidence, ease of training, and greater stability of the device during injection. Reduction of injection-related pain has obvious benefits as far as health-related quality of life.

Using the PharMetrics database, with medical and pharmacy claims of individuals in managed care plans throughout the United States, Dr. Lee and his team retrospectively analyzed 1,156 adults with type 2 diabetes who converted from vial and syringe injection to a pre-filled insulin analogue pen from July 2001 through December 2002. The researchers looked at adherence, hypoglycemic events, the relationship between adherence and hypoglycemic events, and associated health care costs.

The proportion of patients who were adherent was significantly higher after converting to insulin pen therapy, increasing from 36% to 55%. The likelihood of experiencing a hypoglycemic event was also significantly reduced after conversion, by as much as two-thirds for patients with at least 80% adherence. There were significant decreases in hypoglycemia-attributable (HA) emergency department visits and physician visits which led to a reduction in annual HA costs per patient of $788. Other annual diabetes-attributable costs were reduced by $600 per patient and total all-cause annual treatment costs by $1590 per patient.

"The implications of our research are readily apparent," said Dr. Lee. "As evidenced by the marked improvement in medication adherence rates, patients who switched to the insulin pen found that its convenience and ease of use gave them a new ability to self-manage their condition and a resulting freedom from complications and visits to the emergency room. But our study also demonstrated a true ‘win-win’ situation, for individuals with diabetes and for society as a whole, due to significant decreases in the costs associated with hypoglycemic events — events that can be kept at a manageable level or avoidable, as long as a patient adheres to his or her treatment."

Abt Associates, a private, employee-owned company, applies scientific research and technical assistance expertise to a wide range of health, social, economic, and technological policy issues worldwide. Founded in 1965, Abt Associates provides services to a wide array of governmental organizations, international organizations; foundations; and business and industry, including pharmaceutical, medical device and biotech companies. Its staff of over 1,000 is located in offices in Cambridge, Massachusetts; Lexington, Massachusetts; Bethesda, Maryland; Durham, North Carolina; Chicago, Illinois; and around the world in Africa, Asia, Europe, Latin America, and the Middle East.

Clinical Therapeutics 2006 (October); 28

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