Healthcare Costs in People With Type 2 Diabetes Remaining on or Escalating From Basal-Supported Oral Therapy: A 5-Year German Statutory Health Insurance Claims Data Analysis
Author(s)
Christopher Chesters, PhD1, Fleur Levrat Guillen, PharmD2.
1Global Outcomes Research Manager, Abbott, Manchester, United Kingdom, 2Abbott diabetes care, London, United Kingdom.
1Global Outcomes Research Manager, Abbott, Manchester, United Kingdom, 2Abbott diabetes care, London, United Kingdom.
Presentation Documents
OBJECTIVES: To compare differences in healthcare utilisation and costs between patients with type 2 diabetes mellitus (T2DM) who are newly treated with basal-supported oral therapy (BOT) and who either remained on BOT or escsalated to intensified conventional insulin therapy (ICT) over a 5 year-timeframe.
METHODS: An anonymized, representative German claims database covering 2017-2022 with approximately 4.3 million insured persons was used. Index dates were the first prescription of long-acting insulin between 01-Jul-2017 and 31-Dec-2018. Patients newly treated with BOT were identified based on ICD-10 and ATC codes as individuals initiating long-acting insulin therapy without prior prescriptions for short-acting insulin in the preceding 6 months (pre-index). Patients were stratified by follow-up prescription of short-acting insulin into ICT switchers and non-switchers. Healthcare costs and resource utilisation were tracked through to 30-Jun-2022.
RESULTS: 13,584 newly treated BOT patients were included: over the 5-year follow-up 2,322 patients (17.1%) switched to ICT, 10,135 patients (74.6%) did not, with the remainder not included in these cohorts due to censoring or switching during pre-index. During the index period, average costs were similar for ICT switchers (€3,263) and non switchers (€3,041). However, after five years, switchers incurred costs that were 53% higher (€54,803 versus €35,927), primarily driven by hospitalisation and medication expenditures. Patients who switched within six months incurred markedly greater cumulative costs than those who switched after more than 24 months - more than double in Year 1 (~€22 k vs €10 k) and still about 10% higher by Year 5 (€58,413 vs €53,194).
CONCLUSIONS: Switching from BOT to ICT is associated with significantly higher healthcare costs, primarily due to increased inpatient and medication expenditures. Prolonging time on BOT may help reduce long-term healthcare costs; therefore, systematic optimisation of BOT dose or regimen—guided by current diabetes-care standards and supported by continuous glucose monitoring - should be considered before escalating to ICT.
METHODS: An anonymized, representative German claims database covering 2017-2022 with approximately 4.3 million insured persons was used. Index dates were the first prescription of long-acting insulin between 01-Jul-2017 and 31-Dec-2018. Patients newly treated with BOT were identified based on ICD-10 and ATC codes as individuals initiating long-acting insulin therapy without prior prescriptions for short-acting insulin in the preceding 6 months (pre-index). Patients were stratified by follow-up prescription of short-acting insulin into ICT switchers and non-switchers. Healthcare costs and resource utilisation were tracked through to 30-Jun-2022.
RESULTS: 13,584 newly treated BOT patients were included: over the 5-year follow-up 2,322 patients (17.1%) switched to ICT, 10,135 patients (74.6%) did not, with the remainder not included in these cohorts due to censoring or switching during pre-index. During the index period, average costs were similar for ICT switchers (€3,263) and non switchers (€3,041). However, after five years, switchers incurred costs that were 53% higher (€54,803 versus €35,927), primarily driven by hospitalisation and medication expenditures. Patients who switched within six months incurred markedly greater cumulative costs than those who switched after more than 24 months - more than double in Year 1 (~€22 k vs €10 k) and still about 10% higher by Year 5 (€58,413 vs €53,194).
CONCLUSIONS: Switching from BOT to ICT is associated with significantly higher healthcare costs, primarily due to increased inpatient and medication expenditures. Prolonging time on BOT may help reduce long-term healthcare costs; therefore, systematic optimisation of BOT dose or regimen—guided by current diabetes-care standards and supported by continuous glucose monitoring - should be considered before escalating to ICT.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE500
Topic
Economic Evaluation, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)