OBJECTIVE We compared health care resource utilization (HCRU) and costs for inpatient and outpatient services and dispensed medications in older adults with type 2 diabetes initiating empagliflozin versus dipeptidyl peptidase 4 inhibitors (DPP-4is). RESEARCH DESIGN AND METHODS The study population included U.S. Medicare fee-for-service beneficiaries with diabetes (age ≥65 years) initiating empagliflozin or DPP-4is (August 2014 to September 2018). We estimated rate ratios (RRs) for HCRU outcomes using zero-inflated negative binomial regression and per-member per-year (PMPY) cost differences using generalized linear model with gamma distributions, overall and stratified by baseline cardiovascular disease (CVD), after adjusting for 143 baseline covariates using 1:1 propensity score matching. RESULTS We identified 23,335 matched pairs (mean age 72 years, 51% with baseline CVD). HCRU rates were lower in empagliflozin versus DPP-4i initiators (number of inpatient days, RR 0.89 [95% CI 0.82, 0.97]; number of emergency department [ED] visits, 0.86 [0.82, 0.91]; number of hospitalizations, 0.86 [0.79, 0.93]; number of office visits, 0.96 [0.95, 0.98]). Inpatient cost (−$713 PMPY [95% CI −847, −579), outpatient cost (−$198 PMPY[−272, −124]), and total cost of care (−$1,109 PMPY [−1,478, −739]) were lower for empagliflozin versus DPP-4is, although diabetes medication cost was higher in empagliflozin initiators ($454 PMPY [95% CI 284, 567]). In the CVD subgroup, total cost was lower for empagliflozin initiators (−$2,005 PMPY [−2,451, −1,337]), while the difference was attenuated in the non-CVD subgroup (−$296 PMPY[−740, 148]). CONCLUSIONS Among older adults with diabetes, empagliflozin was associated with a lower number of inpatient days, hospitalizations, ED visits, and office visits and with lower costs of care compared with DPP-4is, especially in those with history of CVD.

中文翻译：

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患有 2 型糖尿病的老年人中与恩格列净相关的医疗保健利用和费用


目的 我们比较了开始恩格列净与二肽基肽酶 4 抑制剂 (DPP-4is) 的 2 型糖尿病老年患者的医疗保健资源利用率 (HCRU) 以及住院和门诊服务和配药的费用。研究设计和方法 研究人群包括开始使用恩格列净或 DPP-4is 的美国医疗保险按服务收费的糖尿病受益人（年龄≥65 岁）（2014 年 8 月至 2018 年 9 月）。我们使用零膨胀负二项式回归和每个成员每年 (PMPY) 成本差异，使用具有伽马分布的广义线性模型来估计 HCRU 结果的比率 (RR)，总体并按基线心血管疾病 (CVD) 进行分层，调整后使用 1:1 倾向得分匹配对 143 个基线协变量进行分析。结果 我们确定了 23,335 对配对（平均年龄 72 岁，51% 患有基线 CVD）。恩格列净与 DPP-4i 起始药物相比，HCRU 率较低（住院天数，RR 0.89 [95% CI 0.82，0.97]；急诊科 [ED] 就诊次数，0.86 [0.82，0.91]；住院次数，0.86 [ 0.79，0.93]；办公室访问次数，0.96 [0.95，0.98]）。住院费用（-$713 PMPY [95% CI -847, -579）、门诊费用（-$198 PMPY[-272, -124]）和总护理费用（-$1,109 PMPY [-1,478, -739]）为尽管恩格列净起始剂的糖尿病药物费用较高（454 美元 PMPY [95% CI 284, 567]），但恩格列净的费用低于 DPP-4is。在 CVD 亚组中，恩格列净起始剂的总成本较低（−2,005 美元 PMPY [−2,451, -1,337]），而非 CVD 亚组中的差异有所减弱（−296 美元 PMPY[−740, 148]）。 结论 在老年糖尿病患者中，与 DPP-4is 相比，恩格列净的住院天数、住院次数、急诊就诊次数和就诊次数以及护理费用较低，尤其是有 CVD 病史的患者。