Effect of Combination Cholesterol-Lowering Therapy and Triglyceride-Lowering Therapy on Medical Costs in Patients with Type 2 Diabetes Mellitus
Abstract High triglyceride (TG) levels among patients with type 2 diabetes mellitus (DM) are associated with higher medical costs. We analyzed the economic impact of TG-lowering therapies and whether the association between medical costs and therapy differed according to TG reduction. We conducted a...
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| Veröffentlicht in: | The American journal of cardiology 2017-02, Vol.119 (3), p.410-415 |
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| creator | Nichols, Gregory A., PhD Reynolds, Kristi, PhD Olufade, Temitope, PhD Kimes, Teresa M., MS O’Keeffe-Rosetti, Maureen, MS Sapp, Daniel S., BS Anzalone, Deborah, MD Fortmann, Stephen P., MD |
| description | Abstract High triglyceride (TG) levels among patients with type 2 diabetes mellitus (DM) are associated with higher medical costs. We analyzed the economic impact of TG-lowering therapies and whether the association between medical costs and therapy differed according to TG reduction. We conducted an observational cohort study of 184,932 patients with DM who had a TG measurement between January 2012 and June 2013 and a second TG measurement 3–15 months later. We identified 4 therapy groups (statin monotherapy, TG-specific monotherapy, statin/TG-specific combination therapy, or no therapy) and stratified those groups by percent change in TG (increased > 5%, change of ≤4.9%, decreased 5%–29%, decreased > 30%). We compared change in medical costs between the year before and after therapy, adjusted for demographic and clinical characteristics. Of the 184,932 total patients, 143,549 (77.6%) received statin monotherapy, 900 (0.5%) received TG-specific monotherapy, 1,956 (1.1%) received statin and TG-specific combination therapy, and 38,527 (20.8%) received no prescription lipid agents. After covariate adjustment, statin/TG-specific agent recipients had a mean 1-year total cost reduction of $1,110. The greatest cost reduction was seen among statin/TG-specific combination therapy patients who reduced TG levels by > 30% (–$2,859). Statin monotherapy patients who reduced TG by > 30% also had a large reduction in adjusted costs (–$1,079). In conclusion, we found a substantial economic benefit to treating diabetic patients with statin/TG-specific combination lipid therapy compared with monotherapy of either type or no lipid pharmacotherapy. A TG reduction of > 30% produced a particularly large reduction in 1-year medical costs. |
| doi_str_mv | 10.1016/j.amjcard.2016.10.029 |
| format | Article |
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We analyzed the economic impact of TG-lowering therapies and whether the association between medical costs and therapy differed according to TG reduction. We conducted an observational cohort study of 184,932 patients with DM who had a TG measurement between January 2012 and June 2013 and a second TG measurement 3–15 months later. We identified 4 therapy groups (statin monotherapy, TG-specific monotherapy, statin/TG-specific combination therapy, or no therapy) and stratified those groups by percent change in TG (increased > 5%, change of ≤4.9%, decreased 5%–29%, decreased > 30%). We compared change in medical costs between the year before and after therapy, adjusted for demographic and clinical characteristics. Of the 184,932 total patients, 143,549 (77.6%) received statin monotherapy, 900 (0.5%) received TG-specific monotherapy, 1,956 (1.1%) received statin and TG-specific combination therapy, and 38,527 (20.8%) received no prescription lipid agents. After covariate adjustment, statin/TG-specific agent recipients had a mean 1-year total cost reduction of $1,110. The greatest cost reduction was seen among statin/TG-specific combination therapy patients who reduced TG levels by > 30% (–$2,859). Statin monotherapy patients who reduced TG by > 30% also had a large reduction in adjusted costs (–$1,079). In conclusion, we found a substantial economic benefit to treating diabetic patients with statin/TG-specific combination lipid therapy compared with monotherapy of either type or no lipid pharmacotherapy. A TG reduction of > 30% produced a particularly large reduction in 1-year medical costs.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2016.10.029</identifier><identifier>PMID: 27890243</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Aged ; Alcohol use ; Algorithms ; Body mass index ; Cardiovascular ; Cardiovascular disease ; Cholesterol ; Cholesterol, HDL - blood ; Cholesterol, LDL - blood ; Clinical trials ; Cohort Studies ; Cost-Benefit Analysis ; Costs ; Diabetes ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - economics ; Drug therapy ; Drug Therapy, Combination ; Electronic health records ; Fatty Acids, Omega-3 - therapeutic use ; Female ; Fibric Acids - therapeutic use ; Health Care Costs ; Heart failure ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Hypercholesterolemia - complications ; Hypercholesterolemia - drug therapy ; Hypercholesterolemia - economics ; Hypertriglyceridemia - complications ; Hypertriglyceridemia - drug therapy ; Hypertriglyceridemia - economics ; Hypolipidemic Agents - therapeutic use ; Kidney diseases ; Lipids ; Low density lipoprotein ; Male ; Medical records ; Middle Aged ; Niacin - therapeutic use ; Pharmacy ; Retrospective Studies ; Review boards ; Statins ; Studies ; Triglycerides - blood</subject><ispartof>The American journal of cardiology, 2017-02, Vol.119 (3), p.410-415</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Feb 1, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-fb09bf659469566e33dc7fee5768d13c4394eb161ea826088cb48fb4fa95e3a13</citedby><cites>FETCH-LOGICAL-c481t-fb09bf659469566e33dc7fee5768d13c4394eb161ea826088cb48fb4fa95e3a13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1858171695?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,778,782,3539,27907,27908,45978,64366,64368,64370,72220</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27890243$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nichols, Gregory A., PhD</creatorcontrib><creatorcontrib>Reynolds, Kristi, PhD</creatorcontrib><creatorcontrib>Olufade, Temitope, PhD</creatorcontrib><creatorcontrib>Kimes, Teresa M., MS</creatorcontrib><creatorcontrib>O’Keeffe-Rosetti, Maureen, MS</creatorcontrib><creatorcontrib>Sapp, Daniel S., BS</creatorcontrib><creatorcontrib>Anzalone, Deborah, MD</creatorcontrib><creatorcontrib>Fortmann, Stephen P., MD</creatorcontrib><title>Effect of Combination Cholesterol-Lowering Therapy and Triglyceride-Lowering Therapy on Medical Costs in Patients with Type 2 Diabetes Mellitus</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Abstract High triglyceride (TG) levels among patients with type 2 diabetes mellitus (DM) are associated with higher medical costs. We analyzed the economic impact of TG-lowering therapies and whether the association between medical costs and therapy differed according to TG reduction. We conducted an observational cohort study of 184,932 patients with DM who had a TG measurement between January 2012 and June 2013 and a second TG measurement 3–15 months later. We identified 4 therapy groups (statin monotherapy, TG-specific monotherapy, statin/TG-specific combination therapy, or no therapy) and stratified those groups by percent change in TG (increased > 5%, change of ≤4.9%, decreased 5%–29%, decreased > 30%). We compared change in medical costs between the year before and after therapy, adjusted for demographic and clinical characteristics. Of the 184,932 total patients, 143,549 (77.6%) received statin monotherapy, 900 (0.5%) received TG-specific monotherapy, 1,956 (1.1%) received statin and TG-specific combination therapy, and 38,527 (20.8%) received no prescription lipid agents. After covariate adjustment, statin/TG-specific agent recipients had a mean 1-year total cost reduction of $1,110. The greatest cost reduction was seen among statin/TG-specific combination therapy patients who reduced TG levels by > 30% (–$2,859). Statin monotherapy patients who reduced TG by > 30% also had a large reduction in adjusted costs (–$1,079). In conclusion, we found a substantial economic benefit to treating diabetic patients with statin/TG-specific combination lipid therapy compared with monotherapy of either type or no lipid pharmacotherapy. A TG reduction of > 30% produced a particularly large reduction in 1-year medical costs.</description><subject>Acute coronary syndromes</subject><subject>Aged</subject><subject>Alcohol use</subject><subject>Algorithms</subject><subject>Body mass index</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Cholesterol</subject><subject>Cholesterol, HDL - blood</subject><subject>Cholesterol, LDL - blood</subject><subject>Clinical trials</subject><subject>Cohort Studies</subject><subject>Cost-Benefit Analysis</subject><subject>Costs</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - economics</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>Electronic health records</subject><subject>Fatty Acids, Omega-3 - therapeutic use</subject><subject>Female</subject><subject>Fibric Acids - therapeutic use</subject><subject>Health Care Costs</subject><subject>Heart failure</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>Hypercholesterolemia - complications</subject><subject>Hypercholesterolemia - drug therapy</subject><subject>Hypercholesterolemia - economics</subject><subject>Hypertriglyceridemia - complications</subject><subject>Hypertriglyceridemia - drug therapy</subject><subject>Hypertriglyceridemia - economics</subject><subject>Hypolipidemic Agents - therapeutic use</subject><subject>Kidney diseases</subject><subject>Lipids</subject><subject>Low density lipoprotein</subject><subject>Male</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Niacin - therapeutic use</subject><subject>Pharmacy</subject><subject>Retrospective Studies</subject><subject>Review boards</subject><subject>Statins</subject><subject>Studies</subject><subject>Triglycerides - blood</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNks-O0zAQxi0EYsvCI4AsceGSYsdOYl9AqCx_pCKQKGfLcSZbhzQudsIqT8ErM1ELSMsBTrbHP3-emW8IeczZmjNePu_W9tA5G5t1jkeMrVmu75AVV5XOuObiLlkxxvJMc6kvyIOUOjxyXpT3yUVeKc1yKVbkx1XbghtpaOkmHGo_2NGHgW72oYc0Qgx9tg03EP1wTXd7iPY4Uzs0dBf9dT87vGjgbwIVPkDjne1RNY2J-oF-QmUYcH_jxz3dzUegOX3tbQ0jJMT73o9TekjutbZP8Oi8XpIvb652m3fZ9uPb95tX28xJxcesrZmu27LQstRFWYIQjatagKIqVcOFk0JLqHnJwaq8ZEq5Wqq2lq3VBQjLxSV5dtI9xvBtwlLNwSeHSdgBwpQMV6itsJfVf6BSikKIgiH69BbahSkOWMgiqHjFMV2kihPlYkgpQmuO0R9snA1nZjHXdOZsrlnMXcJoLr57claf6gM0v1_9chOBlycAsHPfPUSTHPbcoRURTTZN8P_84sUtBdf7YTHyK8yQ_lRjUm6Y-bxM2DJgvBS8kkyKn4_RzXA</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Nichols, Gregory A., PhD</creator><creator>Reynolds, Kristi, PhD</creator><creator>Olufade, Temitope, PhD</creator><creator>Kimes, Teresa M., MS</creator><creator>O’Keeffe-Rosetti, Maureen, MS</creator><creator>Sapp, Daniel S., BS</creator><creator>Anzalone, Deborah, MD</creator><creator>Fortmann, Stephen P., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>7QO</scope></search><sort><creationdate>20170201</creationdate><title>Effect of Combination Cholesterol-Lowering Therapy and Triglyceride-Lowering Therapy on Medical Costs in Patients with Type 2 Diabetes Mellitus</title><author>Nichols, Gregory A., PhD ; Reynolds, Kristi, PhD ; Olufade, Temitope, PhD ; Kimes, Teresa M., MS ; O’Keeffe-Rosetti, Maureen, MS ; Sapp, Daniel S., BS ; Anzalone, Deborah, MD ; Fortmann, Stephen P., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-fb09bf659469566e33dc7fee5768d13c4394eb161ea826088cb48fb4fa95e3a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute coronary syndromes</topic><topic>Aged</topic><topic>Alcohol use</topic><topic>Algorithms</topic><topic>Body mass index</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Cholesterol</topic><topic>Cholesterol, HDL - blood</topic><topic>Cholesterol, LDL - blood</topic><topic>Clinical trials</topic><topic>Cohort Studies</topic><topic>Cost-Benefit Analysis</topic><topic>Costs</topic><topic>Diabetes</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - economics</topic><topic>Drug therapy</topic><topic>Drug Therapy, Combination</topic><topic>Electronic health records</topic><topic>Fatty Acids, Omega-3 - therapeutic use</topic><topic>Female</topic><topic>Fibric Acids - therapeutic use</topic><topic>Health Care Costs</topic><topic>Heart failure</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</topic><topic>Hypercholesterolemia - complications</topic><topic>Hypercholesterolemia - drug therapy</topic><topic>Hypercholesterolemia - economics</topic><topic>Hypertriglyceridemia - complications</topic><topic>Hypertriglyceridemia - drug therapy</topic><topic>Hypertriglyceridemia - economics</topic><topic>Hypolipidemic Agents - therapeutic use</topic><topic>Kidney diseases</topic><topic>Lipids</topic><topic>Low density lipoprotein</topic><topic>Male</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Niacin - therapeutic use</topic><topic>Pharmacy</topic><topic>Retrospective Studies</topic><topic>Review boards</topic><topic>Statins</topic><topic>Studies</topic><topic>Triglycerides - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nichols, Gregory A., PhD</creatorcontrib><creatorcontrib>Reynolds, Kristi, PhD</creatorcontrib><creatorcontrib>Olufade, Temitope, PhD</creatorcontrib><creatorcontrib>Kimes, Teresa M., MS</creatorcontrib><creatorcontrib>O’Keeffe-Rosetti, Maureen, MS</creatorcontrib><creatorcontrib>Sapp, Daniel S., BS</creatorcontrib><creatorcontrib>Anzalone, Deborah, MD</creatorcontrib><creatorcontrib>Fortmann, Stephen P., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nichols, Gregory A., PhD</au><au>Reynolds, Kristi, PhD</au><au>Olufade, Temitope, PhD</au><au>Kimes, Teresa M., MS</au><au>O’Keeffe-Rosetti, Maureen, MS</au><au>Sapp, Daniel S., BS</au><au>Anzalone, Deborah, MD</au><au>Fortmann, Stephen P., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Combination Cholesterol-Lowering Therapy and Triglyceride-Lowering Therapy on Medical Costs in Patients with Type 2 Diabetes Mellitus</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>119</volume><issue>3</issue><spage>410</spage><epage>415</epage><pages>410-415</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Abstract High triglyceride (TG) levels among patients with type 2 diabetes mellitus (DM) are associated with higher medical costs. We analyzed the economic impact of TG-lowering therapies and whether the association between medical costs and therapy differed according to TG reduction. We conducted an observational cohort study of 184,932 patients with DM who had a TG measurement between January 2012 and June 2013 and a second TG measurement 3–15 months later. We identified 4 therapy groups (statin monotherapy, TG-specific monotherapy, statin/TG-specific combination therapy, or no therapy) and stratified those groups by percent change in TG (increased > 5%, change of ≤4.9%, decreased 5%–29%, decreased > 30%). We compared change in medical costs between the year before and after therapy, adjusted for demographic and clinical characteristics. Of the 184,932 total patients, 143,549 (77.6%) received statin monotherapy, 900 (0.5%) received TG-specific monotherapy, 1,956 (1.1%) received statin and TG-specific combination therapy, and 38,527 (20.8%) received no prescription lipid agents. After covariate adjustment, statin/TG-specific agent recipients had a mean 1-year total cost reduction of $1,110. The greatest cost reduction was seen among statin/TG-specific combination therapy patients who reduced TG levels by > 30% (–$2,859). Statin monotherapy patients who reduced TG by > 30% also had a large reduction in adjusted costs (–$1,079). In conclusion, we found a substantial economic benefit to treating diabetic patients with statin/TG-specific combination lipid therapy compared with monotherapy of either type or no lipid pharmacotherapy. A TG reduction of > 30% produced a particularly large reduction in 1-year medical costs.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27890243</pmid><doi>10.1016/j.amjcard.2016.10.029</doi><tpages>6</tpages></addata></record> |
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| subjects | Acute coronary syndromes Aged Alcohol use Algorithms Body mass index Cardiovascular Cardiovascular disease Cholesterol Cholesterol, HDL - blood Cholesterol, LDL - blood Clinical trials Cohort Studies Cost-Benefit Analysis Costs Diabetes Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - economics Drug therapy Drug Therapy, Combination Electronic health records Fatty Acids, Omega-3 - therapeutic use Female Fibric Acids - therapeutic use Health Care Costs Heart failure Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Hypercholesterolemia - complications Hypercholesterolemia - drug therapy Hypercholesterolemia - economics Hypertriglyceridemia - complications Hypertriglyceridemia - drug therapy Hypertriglyceridemia - economics Hypolipidemic Agents - therapeutic use Kidney diseases Lipids Low density lipoprotein Male Medical records Middle Aged Niacin - therapeutic use Pharmacy Retrospective Studies Review boards Statins Studies Triglycerides - blood |
| title | Effect of Combination Cholesterol-Lowering Therapy and Triglyceride-Lowering Therapy on Medical Costs in Patients with Type 2 Diabetes Mellitus |
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