ADHERENCE AS A VALUE SIGNAL: EMERGENCY DEPARTMENT UTILIZATION AND COST BURDEN ASSOCIATED WITH GLP-1 RA NON-ADHERENCE IN TYPE 2 DIABETES
Author(s)
Harry Gyimah Gyamfi, MS, Oliver Titus, MS, Garth C Wright, MS, Heather Anderson, MS, PhD.
University of Colorado School of Pharmacy, Aurora, CO, USA.
University of Colorado School of Pharmacy, Aurora, CO, USA.
OBJECTIVES: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for type 2 diabetes (T2D), yet the downstream healthcare resource utilization and cost burden associated with real-world non-adherence remains poorly characterized. This study quantified all-cause and T2D-related emergency department (ED) and inpatient utilization and costs associated with GLP-1 RA non-adherence among commercially insured adults with T2D in the United States.
METHODS: This retrospective new-user cohort study used IQVIA PharMetrics Plus closed health plan claims data from January 1, 2017, to June 30, 2024. Adults with T2D newly initiating a GLP-1 RA with 12 months of continuous enrollment were included. Non-adherence was defined as proportion of days covered <80% during follow-up. Adjusted relative risks (RRs) for any ED visit or inpatient admission were estimated using marginal standardization. Annualized per-patient-year (PPY) utilization and 2024 US dollar allowed costs were estimated using hurdle models for utilization and two-part Gamma models for costs. All models were adjusted for baseline demographics, insurance characteristics, comorbidities, obesity, baseline costs, index agent and year, and follow-up time.
RESULTS: Among 9,500 GLP-1 RA users, 1,217 (12.8%) were non-adherent. Non-adherence was associated with higher adjusted risk of any all-cause ED visit (RR=1.133; 95% CI, 1.053-1.214; p<0.001) and any T2D-related ED visit (RR=1.132; 95% CI, 1.022-1.242; p=0.015). Non-adherent users had 0.119 more all-cause ED visits PPY (95% CI, 0.031-0.207; p=0.008), $197.68 higher all-cause ED costs PPY (95% CI, $94.99-$300.38; p<0.001), and $54.35 higher T2D-related ED costs PPY (95% CI, $11.71-$96.99; p=0.012). No statistically significant differences were observed for inpatient admissions or inpatient costs.
CONCLUSIONS: GLP-1 RA non-adherence was associated with measurable downstream ED utilization and cost burden, but not inpatient burden. These findings suggest that ED-based utilization and costs may represent an early downstream burden of GLP-1 RA non-adherence and support evaluating adherence-support strategies as part of real-world GLP-1 RA value assessment.
METHODS: This retrospective new-user cohort study used IQVIA PharMetrics Plus closed health plan claims data from January 1, 2017, to June 30, 2024. Adults with T2D newly initiating a GLP-1 RA with 12 months of continuous enrollment were included. Non-adherence was defined as proportion of days covered <80% during follow-up. Adjusted relative risks (RRs) for any ED visit or inpatient admission were estimated using marginal standardization. Annualized per-patient-year (PPY) utilization and 2024 US dollar allowed costs were estimated using hurdle models for utilization and two-part Gamma models for costs. All models were adjusted for baseline demographics, insurance characteristics, comorbidities, obesity, baseline costs, index agent and year, and follow-up time.
RESULTS: Among 9,500 GLP-1 RA users, 1,217 (12.8%) were non-adherent. Non-adherence was associated with higher adjusted risk of any all-cause ED visit (RR=1.133; 95% CI, 1.053-1.214; p<0.001) and any T2D-related ED visit (RR=1.132; 95% CI, 1.022-1.242; p=0.015). Non-adherent users had 0.119 more all-cause ED visits PPY (95% CI, 0.031-0.207; p=0.008), $197.68 higher all-cause ED costs PPY (95% CI, $94.99-$300.38; p<0.001), and $54.35 higher T2D-related ED costs PPY (95% CI, $11.71-$96.99; p=0.012). No statistically significant differences were observed for inpatient admissions or inpatient costs.
CONCLUSIONS: GLP-1 RA non-adherence was associated with measurable downstream ED utilization and cost burden, but not inpatient burden. These findings suggest that ED-based utilization and costs may represent an early downstream burden of GLP-1 RA non-adherence and support evaluating adherence-support strategies as part of real-world GLP-1 RA value assessment.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE171
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)