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Evaluation of the Clinical and Economic Burden of Poor Glycemic Control Associated with Therapeutic Inertia in Patients with Type 2 Diabetes in the United States.
- Source :
-
Advances in therapy [Adv Ther] 2020 Feb; Vol. 37 (2), pp. 869-882. Date of Electronic Publication: 2020 Jan 10. - Publication Year :
- 2020
-
Abstract
- Introduction: Therapeutic inertia refers to the failure to initiate or intensify treatment in a timely manner and is widespread in type 2 diabetes (T2D) despite the well-established importance of maintaining good glycemic control. The aim of this analysis was to quantify the clinical and economic burden associated with poor glycemic control due to therapeutic inertia in patients with T2D in the USA.<br />Methods: The IQVIA CORE Diabetes Model was used to simulate life expectancy, costs associated with diabetes-related complications, and lost workplace productivity in US patients. Baseline glycated hemoglobin (HbA1c) levels were 7.0% (53 mmol/mol), 9.0% (75 mmol/mol), 11.0% (97 mmol/mol) 13.0% (119 mmol/mol), or 15.0% (140 mmol/mol), with targets of 6.5% (48 mmol/mol), 7.0% (53 mmol/mol), 8.0% (64 mmol/mol), or 9.0% (75 mmol/mol) depending on baseline HbA1c, across several delayed intensification scenarios (values above target were defined as poor control). The burden associated with intensification delays of 1, 2, 3, 5, and 7 years was estimated over time horizons of 1-30 years. Future costs and clinical benefits were discounted at 3% annually.<br />Results: In a population of 13.4 million patients with T2D and baseline HbA1c of 9.0% (75 mmol/mol), delaying intensification of therapy by 1 year was associated with a loss of approximately 13,390 life-years and increased total costs of US dollars (USD) 7.3 billion (1-year time horizon). Longer delays in intensification were associated with a greater economic burden. Delaying intensification by 7 years was projected to cost approximately 3 million life-years and USD 223 billion over a 30-year time horizon.<br />Conclusion: Therapeutic inertia is common in routine clinical practice and makes a substantial contribution to the burden associated with type 2 diabetes in the USA. Initiatives and interventions aimed at preventing therapeutic inertia are needed to improve clinical outcomes and avoid excess costs.
- Subjects :
- Adult
Aged
Aged, 80 and over
Diabetes Mellitus, Type 2 epidemiology
Female
Humans
Male
Medication Adherence statistics & numerical data
Middle Aged
Patients statistics & numerical data
United States epidemiology
Cost of Illness
Diabetes Mellitus, Type 2 drug therapy
Diabetes Mellitus, Type 2 economics
Hypoglycemic Agents economics
Hypoglycemic Agents therapeutic use
Medication Adherence psychology
Motivation
Patients psychology
Subjects
Details
- Language :
- English
- ISSN :
- 1865-8652
- Volume :
- 37
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Advances in therapy
- Publication Type :
- Academic Journal
- Accession number :
- 31925649
- Full Text :
- https://doi.org/10.1007/s12325-019-01199-8