Expenditures for medicaid patients treated with exenatide compared with other diabetes management regimens.

OBJECTIVE: To compare Medicaid spending among patients with type 2 diabetes mellitus (T2DM) receiving exenatide or other add-on therapies. STUDY DESIGN: Medicaid data in patients with T2DM were compared among those who initiated exenatide, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, or basal insulin. Patients were on a regimen of metformin and/or sulfonylurea for 30 days and continued the next-line therapy for at least 90 days. METHODS: Total inpatient, outpatient, prescription, and total annual health expenditures were compared for 1 year following treatment initiation. Regression analyses were conducted to compare spending; analyses controlled for patient characteristics, year of initiation, and prior therapy. Propensity score matching was used to match patients receiving exenatide with those receiving other therapies, and analyses were repeated with matched cohorts. RESULTS: Of 23,966 eligible patients, 1345 initiated exenatide and 22,621 initiated other therapies. In the unmatched analysis, medical spending was significantly lower in those given exenatide compared with those given other therapies for inpatient ($1945 vs $3893), prescription ($4505 vs $5714), and total costs ($11,830 vs $15,459) (P <.01 for all); outpatient spending was not significantly different ($5380 vs $5853, P = .15). In the matched analysis (n = 1345 for exenatide, n = 1345 non-exenatide), patients receiving exenatide had significantly lower spending in all 4 categories: inpatient ($1945 vs $4242), outpatient ($5380 vs $6826), prescription ($4505 vs $5878), and total ($11,830 vs $16,945) (P <.01 for all). CONCLUSION: Patients with T2DM receiving exenatide had lower annual Medicaid claims costs compared with patients receiving other therapies.