GLP-1 THERAPY IMPROVES GLYCEMIC CONTROL WITH NO DIFFERENCE IN MEDICAL SPENDING: A REAL-WORLD EFFECTIVENESS STUDY
Author(s)
Vrushabh P. Ladage, MS, MHCI1, Jingsan Zhu, MS, MBA1, Wei Wang, PhD1, Yueming Zhao, MPH1, Kristin Linn, PhD1, Ernesto Ulloa-Perez, PhD1, Aidan Crowley, BS1, Jake Carrion, BA1, Maura Boughter-Dornfeld, MPH1, Torrey Shirk, BA1, Jeffrey Tom, MD, MS2, Ezekiel Emanuel, MD, PHD1, Amol Navathe, MD, PHD1;
1University of Pennsylvania, Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, PA, USA, 2Hawaii Service Medical Association, Honolulu, HI, USA
1University of Pennsylvania, Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, PA, USA, 2Hawaii Service Medical Association, Honolulu, HI, USA
OBJECTIVES: Real-world evidence on the clinical and spending effects of glucagon-like peptide-1 receptor agonists (GLP-1s) remains limited. We evaluated the association between GLP-1 initiation and 12-month glycemic outcomes, healthcare utilization, and medical spending among adults with type-2 diabetes (T2DM).
METHODS: We conducted a retrospective cohort study using 2021-2024 medical and pharmacy claims from a regional health plan, including Commercial, Medicare Advantage, and Medicaid members. GLP-1 initiators were required to have ≥6 months of continuous use (proportion of days covered ≥0.80) and 12 months of baseline enrollment. Initiators were indexed to the quarter of the nearest pre-initiation primary care visit; non-initiators were assigned a pseudo-index quarter. Initiators and non-initiators were matched 3:1 on demographics, comorbidities, diabetes duration and complication status, prior utilization, antidiabetic medication use, and baseline outcomes, with exact matching on Lines of Business (LOB), baseline A1C category, diabetes complication status, and prior antidiabetic medication use (excluding SGLT-2s and DPP-4s). Outcomes included follow-up A1C, cardiovascular events, emergency department visits, inpatient utilization, and total medical costs over 12 months. Generalized linear mixed-effects models were used for utilization and cardiovascular outcomes, and linear mixed-effects models were used for A1C and cost outcomes, adjusting for baseline values.
RESULTS: The study included 990 GLP-1 initiators and 2,970 matched non-initiators. After adjustment, GLP-1 use was associated with significantly lower mean A1C at 12 months (−0.71; 95% CI −0.86 to −0.56). There were no significant differences in cardiovascular events (adjusted OR 0.71; 95% CI 0.47-1.09), inpatient visits (AOR 0.86; 95% CI 0.60-1.21), or emergency department visits (AOR 1.03; 95% CI 0.86-1.22). Total medical costs did not differ between groups (−$46; 95% CI −$899 to $807). Findings were consistent across LOBs.
CONCLUSIONS: Among adult members with T2DM, GLP-1 initiation was associated with improved glycemic control without increases in healthcare utilization or total medical costs at 12 months compared with matched non-initiators.
METHODS: We conducted a retrospective cohort study using 2021-2024 medical and pharmacy claims from a regional health plan, including Commercial, Medicare Advantage, and Medicaid members. GLP-1 initiators were required to have ≥6 months of continuous use (proportion of days covered ≥0.80) and 12 months of baseline enrollment. Initiators were indexed to the quarter of the nearest pre-initiation primary care visit; non-initiators were assigned a pseudo-index quarter. Initiators and non-initiators were matched 3:1 on demographics, comorbidities, diabetes duration and complication status, prior utilization, antidiabetic medication use, and baseline outcomes, with exact matching on Lines of Business (LOB), baseline A1C category, diabetes complication status, and prior antidiabetic medication use (excluding SGLT-2s and DPP-4s). Outcomes included follow-up A1C, cardiovascular events, emergency department visits, inpatient utilization, and total medical costs over 12 months. Generalized linear mixed-effects models were used for utilization and cardiovascular outcomes, and linear mixed-effects models were used for A1C and cost outcomes, adjusting for baseline values.
RESULTS: The study included 990 GLP-1 initiators and 2,970 matched non-initiators. After adjustment, GLP-1 use was associated with significantly lower mean A1C at 12 months (−0.71; 95% CI −0.86 to −0.56). There were no significant differences in cardiovascular events (adjusted OR 0.71; 95% CI 0.47-1.09), inpatient visits (AOR 0.86; 95% CI 0.60-1.21), or emergency department visits (AOR 1.03; 95% CI 0.86-1.22). Total medical costs did not differ between groups (−$46; 95% CI −$899 to $807). Findings were consistent across LOBs.
CONCLUSIONS: Among adult members with T2DM, GLP-1 initiation was associated with improved glycemic control without increases in healthcare utilization or total medical costs at 12 months compared with matched non-initiators.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD80
Topic
Health Service Delivery & Process of Care
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), STA: Biologics & Biosimilars