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Geographic Variation in the Utilization of Antihyperglycemic Therapies in the U.S. Medicaid Program at State-Level Using Geographic Information System

Almarhoon, Zahra M, B.S.
http://orcid.org/0000-0002-1056-8084
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1553618550167677

Abstract Details

2019, MS, University of Cincinnati, Pharmacy: Pharmaceutical Sciences.
Objective: Diabetes is one of the most prevalent chronic diseases. This study aimed to examine geographic variation and temporal trends in the utilization of antihyperglycemic therapies among the U.S. Medicaid population compared to diabetes prevalence at state-level using Geographic Information system. Methods: A descriptive, retrospective study design was performed for 2011,2014, and 2016. Study drugs were categorized into biguanides, sulfonylureas-meglitinides, DPP-4 inhibitors, SGLT2-inhibitors, GLP-1 receptor agonists, insulins, and others. The annual number of prescriptions for antihyperglycemic therapies were extracted from the national Medicaid pharmacy database provided by the Centers for Medicare & Medicaid Services. Spatial analysis using ArcMap 10.5.1 was performed to create choropleth maps for diabetes prevalence and point maps for the total number of prescriptions for each antihyperglycemic therapy. The percent change in drug utilization during the study period was calculated per therapeutic class per state. Pearson’s correlation test was also performed to evaluate the correlation between diabetes prevalence and antihyperglycemic therapies’ usage at state level. Results: Utilization of most antihyperglycemic therapies were increased from 2011 to 2016. States with high utilization trends were NY, CA, PA, NJ, AZ, FL, IL, OH, MA, and TX, ranging from 1-fold to 50-fold overall. The five most prescribed antihyperglycemic therapies in 2016 were biguanides (41.95%), long and intermediate-acting insulins (18.9%), short and rapid-acting insulins (12.87%), sulfonylureas-meglitinides (11.37%), and DPP-4-inhibitors (7.87%). Rapidly increasing utilization trends were for GLP-1-receptor agonists, DPP-4-inhibitors, and SGLT2-inhibitors around all states. SGLT2-inhibitors usage in the northeastern states increased by 4 to 26-fold higher than its use in 2014. Sulfonylureas-meglitinides usage decreased in the southeast part of the US by 20%-58% in 2016. There is not any observed correlation between diabetes prevalence and antihyperglycemic medications’ usage. Although diabetes prevalence was the highest in the southern states, Antihyperglycemic therapy utilization in the south were less than other states. Conclusion:Geographic variations in the utilization of antihyperglycemic therapies were existing across all the US especially among new antihyperglycemic therapies (GLP-1-receptor agonists, DPP-4-inhibitors, and SGLT2-inhibitors). Antihyperglycemic therapies’ usage grew rapidly in the northeastern and eastern parts of the US. The pattern of the utilization of antihyperglycemic therapies did not match the pattern of diabetes prevalence.
Jianfei (Jeff) Guo, Ph.D. (Committee Chair)
Diego Cuadros, Ph.D. (Committee Member)
Nicholas Messinger (Committee Member)
86 p.
Pharmaceuticals
Diabetes; Medication use; Drug utilization; Regional variation; GIS; Medicaid

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Citations

  • Almarhoon, Z. M. (2019). Geographic Variation in the Utilization of Antihyperglycemic Therapies in the U.S. Medicaid Program at State-Level Using Geographic Information System [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1553618550167677

    APA Style (7th edition)

  • Almarhoon, Zahra. Geographic Variation in the Utilization of Antihyperglycemic Therapies in the U.S. Medicaid Program at State-Level Using Geographic Information System. 2019. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1553618550167677.

    MLA Style (8th edition)

  • Almarhoon, Zahra. "Geographic Variation in the Utilization of Antihyperglycemic Therapies in the U.S. Medicaid Program at State-Level Using Geographic Information System." Master's thesis, University of Cincinnati, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1553618550167677

    Chicago Manual of Style (17th edition)

ucin1553618550167677
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This open access ETD is published by University of Cincinnati and OhioLINK.