Real-world treatment patterns and cost per patient achieving treatment targets among tirzepatide and semaglutide initiators in US patients with type 2 diabetes.
Meredith M Hoog, Carlos Vallarino, Juan M Maldonado, Michael Grabner, Chia-Chen Teng, Kendra Terrell, Emma L Richard
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引用次数: 0
Abstract
Background: Tirzepatide, a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1) receptor agonist (RA), and semaglutide, a GLP-1 RA, are approved for type 2 diabetes (T2D) management. Clinical trials demonstrated that tirzepatide provided greater hemoglobin A1c and weight reduction vs comparators. Studies using trial-based effect estimates indicate it may also offer a lower cost per patient achieving treatment targets. However, real-world comparative data on treatment patterns, effectiveness, and economic value are limited.
Objective: To compare real-world treatment patterns, A1c and weight outcomes, and type 2 diabetes-related pharmacy (T2D-Rx) costs per patient achieving treatment targets in patients initiating tirzepatide for T2D, stratified by prior GLP-1 RA use.
Methods: This retrospective cohort study used claims and laboratory data from the Healthcare Integrated Research Database. Adults with T2D initiating tirzepatide (Mounjaro only) or semaglutide (Ozempic only) from May 2022 to May 2023 were propensity score matched and classified as naive or non-naive based on GLP-1 RA exposure in the 6 months before initiation. Outcomes over 12 months of follow-up included adherence (proportion of days covered ≥0.80), persistence (no ≥45-day gap), and T2D-Rx cost per responder (mean T2D-related pharmacy cost ÷ proportion achieving treatment target) to achieve A1c (<8%, <7%, ≤6.5%, <5.7%) and weight loss (≥5%, ≥10%, ≥15%) thresholds. Outcomes were compared using chi-square and t-tests.
Results: After matching, 10,702 naive and 5,577 non-naive patient pairs were included in each treatment group. Tirzepatide initiators demonstrated higher adherence (naive: 60% vs 45%; non-naive: 66% vs 48%) and persistence (naive: 62% vs 47%; non-naive: 68% vs 49%) than semaglutide initiators. A greater proportion of tirzepatide users achieved all A1c and weight outcomes, including the most stringent targets of A1c less than 5.7% (naive: 30% vs 18%; non-naive: 17% vs 6%) and weight loss greater than or equal to 15% (naive: 23% vs 10%; non-naive: 17% vs 5%). Tirzepatide also had lower T2D-Rx cost per responder for these most stringent endpoints: A1c less than 5.7% (naive: $45,300 vs $65,300; non-naive: $107,700 vs $270,300) and weight loss greater than or equal to 15% (naive: $62,900 vs $124,400; non-naive: $110,200 vs $326,800), as well as for most other weight loss thresholds. For less stringent A1c goals, T2D-Rx cost per responder was similar across tirzepatide and semaglutide.
Conclusions: In this real-world analysis, tirzepatide demonstrated better adherence, persistence, and A1c and weight reductions and lower T2D-Rx cost per responder for the most stringent treatment targets than semaglutide in both GLP-1 RA-naive and non-naive patients with T2D. These findings support the clinical and economic value of tirzepatide for achieving meaningful treatment outcomes in real-world patient populations.
背景：tizepatide是一种双重葡萄糖依赖的胰岛素性多肽和胰高血糖素样肽-1 （GLP-1）受体激动剂（RA）， semaglutide是一种GLP-1受体激动剂（RA），被批准用于2型糖尿病（T2D）的治疗。临床试验表明，与比较药物相比，替西肽提供了更大的血红蛋白A1c和减肥效果。使用基于试验的效果估计的研究表明，它也可能提供更低的每位患者实现治疗目标的成本。然而，关于治疗模式、有效性和经济价值的真实世界比较数据是有限的。目的：比较现实世界的治疗模式、糖化血红蛋白（A1c）和体重结局，以及在使用替西肽治疗T2D的患者中，每位患者实现治疗目标的2型糖尿病相关药物（T2D- rx）成本，并按既往使用GLP-1 RA进行分层。方法：这项回顾性队列研究使用来自医疗保健综合研究数据库的索赔和实验室数据。2022年5月至2023年5月期间，T2D成人患者开始使用替西帕肽（仅限Mounjaro）或西马鲁肽（仅限Ozempic）进行倾向评分匹配，并根据开始前6个月GLP-1 RA暴露情况分类为幼稚或非幼稚。12个月随访的结果包括坚持治疗（覆盖天数占比≥0.80）、持续治疗（无≥45天差距）和每个应答者的T2D-Rx成本（t2d相关平均药费÷达到治疗目标的比例）达到A1c。结果：匹配后，每个治疗组纳入10,702对初治患者和5,577对非初治患者。替西帕肽启动剂的依从性（初始：60% vs 45%；非初始：66% vs 48%）和持久性（初始：62% vs 47%；非初始：68% vs 49%）高于西马鲁肽启动剂。更大比例的替西帕肽使用者达到了所有的糖化血红蛋白和体重指标，包括糖化血红蛋白小于5.7%的最严格目标（新手：30% vs 18%；非新手：17% vs 6%）和体重减轻大于或等于15%（新手：23% vs 10%；非新手：17% vs 5%）。对于这些最严格的终点：A1c小于5.7%（初始值：45,300美元vs 65,300美元；非初始值：107,700美元vs 270,300美元）和体重减轻大于或等于15%（初始值：62,900美元vs 124,400美元；非初始值：110,200美元vs 326,800美元），以及大多数其他减肥阈值，替西帕肽的每个应答者的T2D-Rx成本也较低。对于不太严格的A1c目标，每个应答者的T2D-Rx成本在替西帕肽和西马鲁肽中相似。结论：在这项现实世界的分析中，对于GLP-1 ra初始和非初始T2D患者，替西帕肽在最严格的治疗目标上表现出更好的依从性、持久性、A1c和体重降低以及更低的T2D- rx成本。这些发现支持了替西肽在现实世界患者群体中实现有意义的治疗结果的临床和经济价值。
期刊介绍：
JMCP welcomes research studies conducted outside of the United States that are relevant to our readership. Our audience is primarily concerned with designing policies of formulary coverage, health benefit design, and pharmaceutical programs that are based on evidence from large populations of people. Studies of pharmacist interventions conducted outside the United States that have already been extensively studied within the United States and studies of small sample sizes in non-managed care environments outside of the United States (e.g., hospitals or community pharmacies) are generally of low interest to our readership. However, studies of health outcomes and costs assessed in large populations that provide evidence for formulary coverage, health benefit design, and pharmaceutical programs are of high interest to JMCP’s readership.
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