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Cost Utility Analysis of Fixed Dose and Free Dose Combinations of Oral Medications in Type 2 Diabetes Patients

Anupindi, Vamshi Ruthwik
http://rave.ohiolink.edu/etdc/view?acc_num=mco1438889070

Abstract Details

, Master of Science (MS), University of Toledo, Pharmaceutical Sciences (Health Outcomes and Socioeconomic Sciences).
Background: Type 2 diabetes is a major healthcare problem, being the seventh leading cause of death in United States. Most of the diabetic patients require more than one oral anti diabetic medications and combination therapy is common among them. Fixed dose combinations, medications with more than one active drug ingredients in them, have been a strategy to enhance adherence but it has not been determined at what cost and has not been compared with the free dose combinations. Objective: The objective of the study is to evaluate the cost effectiveness of fixed drug combinations (FXD) versus the free dose combinations (FRC) of oral medications among Type 2 Diabetes patients. Methods: This is a cost utility analysis using the retrospective database, Medical Expenditure Panel Survey (MEPS), a nationally representative data of the US population. The study was done from a third party payer perspective. The study population includes all the respondents diagnosed with Type 2 diabetes and over the age of 18 years and who are also taking at least two or more than two active drug ingredients for Type 2 diabetes oral medications. The sample was divided into two cohorts, FXD group which has patients taking only FXD medication and FRC group which has patients not taking any FXD medication and only their individual component drugs. The costs include only direct costs and the effectiveness was measured in QALYs (Quality Adjusted Life Years) by using utility score from Short Form – 6D (SF-6D). To control for the external validity, a propensity score matching technique was performed to match these two cohorts based on different criteria. Sensitivity analysis was performed to assess the impact of different scenarios and assumptions on results from the model. Results: Five hundred and seventy eight patients were identified from the MEPS database that satisfied the inclusion and exclusion criteria, of which 25.6 % (n = 147) were on FXD formulation. On matching, they were 93 patients in the FXD and FRC group respectively and these groups did not have any differences in various socio demographic, insurance and health status variables. The mean annual cost of FXD group was $ 6016.65 and $ 6919.58 for the FRC group. The mean utility gained by using FXD over FRC was 0.04. The base case analysis shows that the costs of FXD are less and there is a gain in QALY over FRC, so FXD is a dominating strategy over FRC. Probabilistic sensitivity analysis showed FXD was dominating FRC at all willingness to pay (WTP) values. Sensitivity analysis of the annual expenditures at 5th-95th percentile and 10th-90th percentile also showed that FXD were a dominating strategy over FRCs. Discussion: Several studies have identified that FXD have a greater adherence rates among patients and show better clinical outcomes compared to FRCs. This is one of the first studies to show that FXD are cost effective compared to FRCs. Although the cost effectiveness of a single pill strategy was within the acceptable willingness to pay threshold, the QALY difference was minimal. Further research is recommended in this area to look into long term impact in terms of the quality of life of patients using these drugs.
Varun Vaidya, Ph.D. (Committee Chair)
Sharrel Pinto, Ph.D. (Committee Member)
Megan Kaun, Pharm.D. (Committee Member)
Economics; Health Care; Pharmacy Sciences
Cost utility analysis, Fixed dose combinations, Diabetes, MEPS

Recommended Citations

Citations

  • Anupindi, V. R. (n.d.). Cost Utility Analysis of Fixed Dose and Free Dose Combinations of Oral Medications in Type 2 Diabetes Patients [Master's thesis, University of Toledo]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=mco1438889070

    APA Style (7th edition)

  • Anupindi, Vamshi Ruthwik. Cost Utility Analysis of Fixed Dose and Free Dose Combinations of Oral Medications in Type 2 Diabetes Patients. University of Toledo, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=mco1438889070.

    MLA Style (8th edition)

  • Anupindi, Vamshi Ruthwik. "Cost Utility Analysis of Fixed Dose and Free Dose Combinations of Oral Medications in Type 2 Diabetes Patients." Master's thesis, University of Toledo. Accessed MAY 20, 2024. http://rave.ohiolink.edu/etdc/view?acc_num=mco1438889070

    Chicago Manual of Style (17th edition)

mco1438889070
1,148
© , some rights reserved.Creative Commons License Cost Utility Analysis of Fixed Dose and Free Dose Combinations of Oral Medications in Type 2 Diabetes Patients by Vamshi Ruthwik Anupindi is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. Based on a work at etd.ohiolink.edu.
This open access ETD is published by University of Toledo Health Science Campus and OhioLINK.