Costs and Treatment Pathways for Type 2 Diabetes in the UK: A Mastermind Cohort Study

Peter Eibich (Lead / Corresponding author), Amelia Green, Andrew T. Hattersley, Christopher Jennison, Mike Lonergan, Ewan R Pearson, Alastair M. Gray

Research output: Contribution to journalArticle

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Abstract

Introduction: Medication therapy for type 2 diabetes has become increasingly complex, and there are few reliable data on the current state of clinical practice. We report treatment pathways and associated costs of medication therapy for people with type 2 diabetes in the UK, their variability and changes over time.

Methods: Prescription and biomarker data for 7159 people with type 2 diabetes were extracted from the GoDARTS cohort study, covering the period 1989-2013. Average follow-up was 10 years. Individuals were prescribed on average 2.4 (SD: 1.2) drugs with average annual costs of £241. We calculated summary statistics for first- and second-line therapies. Linear regression models were used to estimate associations between therapy characteristics and baseline patient characteristics.

Results: Average time from diagnosis to first prescription was 3 years (SD: 4.0 years). Almost all first-line therapy (98%) was monotherapy, with average annual cost of £83 (SD: £204) for 3.8 (SD: 3.5) years. Second-line therapy was initiated in 73% of all individuals, at an average annual cost of £219 (SD: £305). Therapies involving insulin were markedly more expensive than other common therapies. Baseline HbA1c was unrelated to future therapy costs, but higher average HbA1c levels over time were associated with higher costs.

Conclusions: Medication therapy has undergone substantial changes during the period covered in this study. For example, therapy is initiated earlier and is less expensive than in the past. The data provided in this study will prove useful for future modelling studies, e.g. of stratified treatment approaches.

Original languageEnglish
Pages (from-to)1031-1045
Number of pages15
JournalDiabetes Therapy
Volume8
Issue number5
Early online date6 Sep 2017
DOIs
Publication statusPublished - Oct 2017

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Health Care Costs
Type 2 Diabetes Mellitus
Cohort Studies
Costs and Cost Analysis
Therapeutics
Prescriptions
Linear Models
Biomarkers
Insulin

Keywords

  • Costs
  • First-line therapy
  • Medication therapy
  • Second-line therapy
  • Therapy initiation
  • Type 2 diabetes
  • UK

Cite this

Eibich, Peter ; Green, Amelia ; Hattersley, Andrew T. ; Jennison, Christopher ; Lonergan, Mike ; Pearson, Ewan R ; Gray, Alastair M. / Costs and Treatment Pathways for Type 2 Diabetes in the UK : A Mastermind Cohort Study. In: Diabetes Therapy. 2017 ; Vol. 8, No. 5. pp. 1031-1045.
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abstract = "Introduction: Medication therapy for type 2 diabetes has become increasingly complex, and there are few reliable data on the current state of clinical practice. We report treatment pathways and associated costs of medication therapy for people with type 2 diabetes in the UK, their variability and changes over time.Methods: Prescription and biomarker data for 7159 people with type 2 diabetes were extracted from the GoDARTS cohort study, covering the period 1989-2013. Average follow-up was 10 years. Individuals were prescribed on average 2.4 (SD: 1.2) drugs with average annual costs of £241. We calculated summary statistics for first- and second-line therapies. Linear regression models were used to estimate associations between therapy characteristics and baseline patient characteristics.Results: Average time from diagnosis to first prescription was 3 years (SD: 4.0 years). Almost all first-line therapy (98{\%}) was monotherapy, with average annual cost of £83 (SD: £204) for 3.8 (SD: 3.5) years. Second-line therapy was initiated in 73{\%} of all individuals, at an average annual cost of £219 (SD: £305). Therapies involving insulin were markedly more expensive than other common therapies. Baseline HbA1c was unrelated to future therapy costs, but higher average HbA1c levels over time were associated with higher costs.Conclusions: Medication therapy has undergone substantial changes during the period covered in this study. For example, therapy is initiated earlier and is less expensive than in the past. The data provided in this study will prove useful for future modelling studies, e.g. of stratified treatment approaches.",
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Costs and Treatment Pathways for Type 2 Diabetes in the UK : A Mastermind Cohort Study. / Eibich, Peter (Lead / Corresponding author); Green, Amelia; Hattersley, Andrew T.; Jennison, Christopher; Lonergan, Mike; Pearson, Ewan R; Gray, Alastair M.

In: Diabetes Therapy, Vol. 8, No. 5, 10.2017, p. 1031-1045.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Costs and Treatment Pathways for Type 2 Diabetes in the UK

T2 - A Mastermind Cohort Study

AU - Eibich, Peter

AU - Green, Amelia

AU - Hattersley, Andrew T.

AU - Jennison, Christopher

AU - Lonergan, Mike

AU - Pearson, Ewan R

AU - Gray, Alastair M.

N1 - The authors gratefully acknowledge funding by the Medical Research Council (MRC) and the Association of the British Pharma Industry (ABPI) for “Mastermind” (MRC APBI STratification and Extreme Response Mechanism IN Diabetes–MASTERMIND. Grant Ref.: MRIK005707/1). ERP holds Wellcome Trust New Investigator award 102820/Z/13/Z. GoDARTS was funded by the Wellcome Trust as the Wellcome Trust Type 2 diabetes case control study. The funders were not involved in any way in the research reported in this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole and have given final approval to the version to be published.

PY - 2017/10

Y1 - 2017/10

N2 - Introduction: Medication therapy for type 2 diabetes has become increasingly complex, and there are few reliable data on the current state of clinical practice. We report treatment pathways and associated costs of medication therapy for people with type 2 diabetes in the UK, their variability and changes over time.Methods: Prescription and biomarker data for 7159 people with type 2 diabetes were extracted from the GoDARTS cohort study, covering the period 1989-2013. Average follow-up was 10 years. Individuals were prescribed on average 2.4 (SD: 1.2) drugs with average annual costs of £241. We calculated summary statistics for first- and second-line therapies. Linear regression models were used to estimate associations between therapy characteristics and baseline patient characteristics.Results: Average time from diagnosis to first prescription was 3 years (SD: 4.0 years). Almost all first-line therapy (98%) was monotherapy, with average annual cost of £83 (SD: £204) for 3.8 (SD: 3.5) years. Second-line therapy was initiated in 73% of all individuals, at an average annual cost of £219 (SD: £305). Therapies involving insulin were markedly more expensive than other common therapies. Baseline HbA1c was unrelated to future therapy costs, but higher average HbA1c levels over time were associated with higher costs.Conclusions: Medication therapy has undergone substantial changes during the period covered in this study. For example, therapy is initiated earlier and is less expensive than in the past. The data provided in this study will prove useful for future modelling studies, e.g. of stratified treatment approaches.

AB - Introduction: Medication therapy for type 2 diabetes has become increasingly complex, and there are few reliable data on the current state of clinical practice. We report treatment pathways and associated costs of medication therapy for people with type 2 diabetes in the UK, their variability and changes over time.Methods: Prescription and biomarker data for 7159 people with type 2 diabetes were extracted from the GoDARTS cohort study, covering the period 1989-2013. Average follow-up was 10 years. Individuals were prescribed on average 2.4 (SD: 1.2) drugs with average annual costs of £241. We calculated summary statistics for first- and second-line therapies. Linear regression models were used to estimate associations between therapy characteristics and baseline patient characteristics.Results: Average time from diagnosis to first prescription was 3 years (SD: 4.0 years). Almost all first-line therapy (98%) was monotherapy, with average annual cost of £83 (SD: £204) for 3.8 (SD: 3.5) years. Second-line therapy was initiated in 73% of all individuals, at an average annual cost of £219 (SD: £305). Therapies involving insulin were markedly more expensive than other common therapies. Baseline HbA1c was unrelated to future therapy costs, but higher average HbA1c levels over time were associated with higher costs.Conclusions: Medication therapy has undergone substantial changes during the period covered in this study. For example, therapy is initiated earlier and is less expensive than in the past. The data provided in this study will prove useful for future modelling studies, e.g. of stratified treatment approaches.

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