Impact of Initiating Insulin Glargine Disposable Pen Versus Vial/Syringe on Real-World Glycemic Outcomes and Persistence Among Patients with Type 2 Diabetes Mellitus in a Large Managed Care Plan: A Claims Database Analysis

Background: Diabetes accounts for almost 15% of all direct healthcare expenditures. Managed care organizations try to reduce costs and improve patient outcomes. Increasing patient persistence with antidiabetes treatment could help achieve these goals. Subjects and Methods: A retrospective study was conducted using the Optum Research Database (Optum, Eden Prairie, MN) to analyze clinical and economic outcomes associated with initiation of insulin glargine via a disposable pen (GLA-P) or vial and syringe (GLA-V) among adult, insulin-naive patients with type 2 diabetes mellitus (T2DM). Propensity-matched patient cohorts were assessed for persistence with insulin therapy, glycated hemoglobin (A1C), hypoglycemic events (based on diagnosis codes), and healthcare costs (total paid amount of adjudicated claims) after follow-up at 1 year. Results: In 1,308 matched patients, persistence was significantly higher (P=0.011) and longer (P=0.001) with GLA-P. Follow-up A1C values were significantly lower (P=0.038), and decreases in A1C from baseline significantly larger (P=0.043), in GLA-P than in GLA-V. Significantly fewer hypoglycemic events (P=0.042) were experienced, and a lower rate of diabetes-related inpatient admissions (P=0.008) was reported in GLA-P than GLA-V. Despite higher study drug costs with GLA-P than GLA-V, all-cause and diabetes-related healthcare costs were similar. Conclusions: In insulin-naive patients with T2DM, initiation of insulin glargine using the disposable pen rather than the vial and syringe is associated with higher persistence, better A1C control, and lower rates of hypoglycemia. The higher study drug costs associated with pen use do not increase total all-cause or diabetes-related healthcare costs. This may help treatment selection for patients with T2DM in a managed care setting.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140354/1/dia.2013.0312.pd

The use of decomposition methods in real-world treatment benefits evaluation for patients with type 2 diabetes initiating different injectable therapies: findings from the Initiator study

Onur Başer (MEF Author)Background: Determining characteristics of patients likely to benefit from a particular treatment could help physicians set personalized targets. OBJECTIVES: To use decomposition methodology on real-world data to identify the relative contributions of treatment effects and patients' baseline characteristics. METHODS: Decomposition analyses were performed on data from the Initiation of New Injectable Treatment Introduced after Antidiabetic Therapy with Oral-only Regimens (INITIATOR) study, a real-world study of patients with type 2 diabetes started on insulin glargine (GLA) or liraglutide (LIRA). These analyses investigated relative contributions of differences in baseline characteristics and treatment effects to observed differences in 1-year outcomes for reduction in glycated hemoglobin A1c (HbA1c) and treatment persistence. RESULTS: The greater HbA1c reduction seen with GLA compared with LIRA (-1.39% vs. -0.74%) was primarily due to differences in baseline characteristics (HbA1c and endocrinologist as prescribing physician; P < 0.050). Patients with baseline HbA1c of 9.0% or more or evidence of diagnosis codes related to mental illness achieved greater HbA1c reductions with GLA, whereas patients with baseline polypharmacy (6-10 classes) or hypogylcemia achieved greater reductions with LIRA. Decomposition analyses also showed that the higher persistence seen with GLA (65% vs. 49%) was mainly caused by differences in treatment effects (P < 0.001). Patients 65 years and older, those with HbA1c of 9.0% or more, those taking three oral antidiabetes drugs, and those with polypharmacy of more than 10 classes had higher persistence with GLA; patients 18 to 39 years and those with HbA1c of 7.0% to less than 8.0% had higher persistence with LIRA. CONCLUSIONS: Although decomposition does not demonstrate causal relationships, this method could be useful for examining the source of differences in outcomes between treatments in a real-world setting and could help physicians identify patients likely to respond to a particular treatment. Copyright (C) 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.WOS:000419245600004Scopus - Affiliation ID: 60105072PMID: 29241884Science Citation Index Expanded - Social Sciences Citation IndexQ1ArticleUluslararası işbirliği ile yapılan - EVETAralık2017YÖK - 2017-1

Comparison of cohesive powder flowability measured by Schulze Shear Cell, Raining Bed Method, Sevilla Powder Tester and new Ball Indentation Method

Poor powder flow leads to many problems during manufacturing and can lead to inaccurate dosing and off-specification products. Powder flowability is commonly assessed under relatively high applied loads using shear cells by characterising the unconfined yield strength at a range of applied loads. For applied stresses below 1 kPa, it becomes increasingly difficult to obtain reliable values of the unconfined yield strength. The bulk cohesion and tensile strength of the powder are then obtained by extrapolating the yield locus to zero and negative loads, respectively. However, the reliability of this approximation for a given material is not known. To overcome this limitation, techniques such as the Raining Bed Method, Sevilla Powder Tester and the newly-developed Ball Indentation Method may be used. In this paper, we report our measurement results of the tensile strength of glass beads, α-lactose monohydrate and various sizes of fluid catalytic cracking powders determined by the Sevilla Powder Tester and Raining Bed Method and compare them with those inferred from the Schulze Shear Cell. The results of the latter are also compared with those of the Ball Indentation Method. The outcome suggests that in the case of shear cell tests, the extrapolation of the yield locus to lower or negative loads is unsafe. The ball indentation method enables the characterisation of highly cohesive powders at very low compressive loads; however extrapolation to negative loads is still not reliable. In contrast, the Sevilla Powder Tester and Raining Bed Methods are able to characterise the tensile strength directly, but high bulk cohesion poses difficulties as the internal bed failure needs to be analysed in order to reliably estimate the tensile strength. These methods provide a better understanding of powder flow behaviour at low stresses, thus enabling a greater control of manufacturing processes

The implementation of decentralised biogas plants in Assam, NE India: the impact and effectiveness of the National Biogas and Manure Management Programme

The Indian Government’s National Biogas and Manure Management Programme (NBMMP) aims to deliver renewable energy services to households across the country by incentivising the deployment of family-sized (<6m3) anaerobic (biogas) digesters. We investigated how NBMMP policy is implemented at three levels, from government and state nodal agency, via private contractors to households. We analysed the scheme across two districts in Assam, north-east India, interviewing stakeholders in rural households, state and non-state institutions. We found a top-down, supply-side approach which enables central government to set targets and require individual states to deploy the scheme. Participation in the NBMMP was found to deliver improved energy service outcomes to a majority of households that can afford to participate, although the level of knowledge and understanding of the technology amongst users was limited. Improved training of householders, and particularly women, is needed in relation to the maintenance of digesters, feedstock suitability and the environmental and potential livelihood benefits of digestate. A policy revision which highlights the contextual and demand-side issues around adopting the technology, may deliver monetary benefits from market competition and enable development of community-focused microfinance schemes to improve the affordability of biogas systems