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Economic Impact of and Treatment Options for Type 2 Diabetes
Jan D. Hirsch, BSPharm, PhD, and Candis M. Morello, PharmD, CDE
Strategies for Addressing the Cost of Nonadherence in Diabetes
Candis M. Morello, PharmD, CDE, and Jan D. Hirsch, BSPharm, PhD
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Utilizing Advances in Diabetes and Targeting Medication Adherence to Enhance Clinical Outcomes and Manage Costs for Type 2 Diabetes Posttest

Economic Impact of and Treatment Options for Type 2 Diabetes

Jan D. Hirsch, BSPharm, PhD, and Candis M. Morello, PharmD, CDE
Treatment Challenges: Need for Additional Data
To achieve this collaborative care and patient-centered approach, it is crucial to understand the various treatment challenges (ie, areas in diabetes care that are currently lacking or missing). Several that are relevant to the managed care perspective are briefly discussed below.

Lack of Comparative Effectiveness Data
Clinical trials directly comparing clinical outcomes of diabetes medications are lacking.13 Not having comparative effectiveness data makes drug therapy decisions challenging for prescribers and managed care decision makers. Conducting these trials can be difficult because of the number of different therapies available, interpatient variability, multiple second- and third-line options, and the rapidly developing diabetes marketplace. A potential recommendation to close this gap is for the FDA approval process to require head-to-head comparison trials based on guideline-recommended treatment combinations for all investigational diabetes medications.13

Need for Patient-Reported Outcomes Data
Diabetes clinical trials assessing patient-reported outcomes (PROs) are lacking.13  These measures provide valuable information regarding the patient’s perspective on the benefits and adverse events of real-world medication use (eg, impact on physical, mental, and social well-being). Encouraging manufacturers and others who are conducting large-scale clinical trials to use a standard set of PROs for diabetes medications would facilitate comparison of these important outcomes. The National Institutes of Health’s Patient-Reported Outcomes Measurement Information System (PROMIS) program could serve as a model.13,14 PROMIS is a rigorously tested measurement tool that uses advanced information technology and psychometrics, as well as qualitative, cognitive, and health survey research techniques, to measure PROs.14

Time and Compensation for Alternative Care Delivery Models
Patients with diabetes who were managed in a collaborative practice model and who received additional time beyond usual care to receive patient education and clinical care led to significant positive outcomes and cost avoidance.8 The collaborative practice model consisted of an endocrinologist and pharmacist-CDE. Compared with usual PCP visits, the pharmacist spent more time (60 minutes) with patients. Cost-effectiveness was demonstrated from the clinic, health system, and payer perspectives. At 6 months, mean A1C significantly improved in the intervention group compared with the usual care (PCP) group (2.4 ± 2.1 vs –0.8 ± 1.7, respectively; P <.001).12 Significantly more patients met A1C goals (at 3 and 6 months) in the intervention group compared with control-group patients. This model is unique and promising because there was a limited time-intense pharmacist intervention phase (mean of 3 visits within 6 months) and then the patient was discharged back to their PCP for ongoing care. This demonstrated that substantial clinical improvements can be observed in a short period of time and at a limited cost.8 Despite these positive outcomes, this practice model is not commonly used and would likely not be covered by health insurance unless “incident to” or medication therapy management billing codes are used.

Knowledge of Diabetes Medication Use and Outcomes in Different Races and Ethnicities
Certain medications, such as sulfonylureas, miglitol, metformin, and rosiglitazone, have been evaluated in African American, Hispanic, and Asian populations.15 However, studies are lacking for other, newer diabetes medications in nonwhite races/ethnicities. These studies are needed to determine if efficacy, adverse effects (AEs), or usage vary based on the individual’s race/ethnicity.



 
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