PMID- 26473990
OWN - NLM
STAT- MEDLINE
DCOM- 20161216
LR  - 20220409
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 19
IP  - 3
DP  - 2016
TI  - A retrospective study of persistence, adherence, and health economic outcomes of 
      fixed-dose combination vs. loose-dose combination of oral anti-diabetes drugs.
PG  - 203-12
LID - 10.3111/13696998.2015.1109518 [doi]
AB  - OBJECTIVE: To compare outcomes between patients with type 2 diabetes mellitus 
      (T2DM) using fixed-dose combination (FDC) and loose-dose combination (LDC) 
      products. METHODS: This retrospective cohort study used MarketScan Commercial and 
      Medicare Supplemental data from January 1, 2009-December 31, 2013. The identified 
      population included patients with T2DM and >/=1 additional oral anti-diabetic 
      prescription (of the same regimen [FDC/LDC] as the index prescription) within 12 
      months following the fill date. Persistence (no >/=30-day gap) and adherence 
      (medication possession ratio [MPR] >/=0.8) were assessed as primary end-points; 
      secondary end-points included hypoglycemia, healthcare resource utilization, and 
      costs. RESULTS: Of 23,361 patients identified, 12,590 (53.9%) were on FDC therapy 
      and 10,771 (46.1%) were on LDC therapy. FDC patients had a significantly lower 
      rate of non-persistence (67.9% vs. 73.4%, p < 0.0001) and a significantly higher 
      rate of adherence to therapy (57.0% vs. 50.7%, p < 0.0001) when compared to LDC 
      patients. Average time to non-persistence was significantly longer among FDC vs. 
      LDC patients (207.1 vs. 186.3 days, p < 0.0001). After adjusting for baseline 
      characteristics, the odds of non-persistence were 21% lower with FDC vs. LDC 
      therapy (OR = 0.79, 95% CI = 0.74-0.85, p < 0.0001), with a 28% higher odds of 
      adherence (OR = 1.28, 95% CI = 1.20-1.36, p < 0.0001). Differences in most 
      secondary outcomes significantly favored FDC therapy, including total predicted 
      monthly all-cause costs ($1008 vs. $1053; p = 0.006) and T2DM-related costs ($142 
      vs. $155; p < 0.001). LIMITATIONS: Cohort classification was based on 
      prescription claims data. The lack of clinical data limits assessment of 
      potential influencers of FDC vs. LDC decisions, residual confounding was 
      possible, and diabetes-related medical costs only captured claims with a primary 
      diagnosis for diabetes. The results may not be generalizable to populations such 
      as Medicaid. CONCLUSION: Management of T2DM using FDC therapies provides a 
      compliance benefit relative to LDC therapies that may translate to reductions in 
      healthcare utilization and costs.
FAU - Lokhandwala, Tasneem
AU  - Lokhandwala T
AD  - a a Xcenda , Tampa , FL , USA.
FAU - Smith, Nancy
AU  - Smith N
AD  - b b Bristol-Myers Squibb , Princeton , NJ , USA.
FAU - Sternhufvud, Catarina
AU  - Sternhufvud C
AD  - c c AstraZeneca , Molndal , Sweden.
FAU - Sorstadius, Elisabeth
AU  - Sorstadius E
AD  - c c AstraZeneca , Molndal , Sweden.
FAU - Lee, Won Chan
AU  - Lee WC
AD  - d d Xcenda , San Bruno , CA , USA.
FAU - Mukherjee, Jayanti
AU  - Mukherjee J
AD  - e e Bristol-Myers Squibb , Wallingford , CT , USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20151130
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Drug Combinations)
RN  - 0 (Hypoglycemic Agents)
SB  - IM
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Drug Combinations
MH  - Drug Therapy, Combination/economics
MH  - Female
MH  - Humans
MH  - Hypoglycemic Agents/*administration & dosage/*economics
MH  - Insurance Claim Review
MH  - Male
MH  - Medicare/economics
MH  - Medication Adherence
MH  - Middle Aged
MH  - Retrospective Studies
MH  - United States
OTO - NOTNLM
OT  - Adherence
OT  - Costs
OT  - Diabetes
OT  - Fixed dose combination
OT  - Persistence
EDAT- 2015/10/17 06:00
MHDA- 2016/12/17 06:00
CRDT- 2015/10/17 06:00
PHST- 2015/10/17 06:00 [entrez]
PHST- 2015/10/17 06:00 [pubmed]
PHST- 2016/12/17 06:00 [medline]
AID - 10.3111/13696998.2015.1109518 [doi]
PST - ppublish
SO  - J Med Econ. 2016;19(3):203-12. doi: 10.3111/13696998.2015.1109518. Epub 2015 Nov 
      30.