IntroductionThe objective of this study was to evaluate real-world treatment patterns of type 2 diabetes (T2D) patients initiating glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in Germany (GE), the United Kingdom (UK), France (FR), the Netherlands (NE), Belgium (BE), and Sweden (SE).MethodsAdult T2D patients initiating exenatide twice daily (exBID), liraglutide once daily (LIRA) or exenatide once weekly (exQW) were identified using the IMS LifeLink™ (IMS Health, Danbury, CT, USA): Electronic Medical Records (EMR; GE/UK/FR) and IMS LifeLink™: longitudinal prescriptions (LRx; NE/BE/GE/UK) databases, and national health register data (SE), between 2010 and 2012. Therapy initiation date was termed ‘index date’. Eligible patients had ≥180-day pre- and variable follow-up (minimum ≥360-day post-index exBID and LIRA, ≥180-day post-index exQW). Treatment modification and persistence were evaluated over 180 days. Kaplan–Meier (KM) survival curves and Cox proportional hazards models (PHMs; EMR databases only) evaluated stopping of the index therapy (measured as first of discontinuation or switch).Results30,206 exBID, 5,401 exQW, and 52,155 LIRA patients were included in the analysis (46.0–66.9% male; mean age range 55.4–59.3 years). Mean follow-up was 20.3–27.4 months for exBID and LIRA, and 7.6–13.9 months for exQW. Across the databases, the proportion experiencing a treatment modification at 180 days was highest among exBID (37.6–81.7%) compared to LIRA (36.8–56.6%) and exQW (32.3–47.7%). The proportion persistent at 180 days was lowest among exBID patients (46.8–73.5%) compared to LIRA (50.6–80.1%) or exQW (57.5–74.6%). In the KM analyses, LIRA patients had a lower proportion stopping therapy at all time points compared to exBID patients, across the databases. In the Cox PHMs, LIRA was associated with a significantly lower risk of stopping compared to exBID; in GE, exQW was associated with a lower risk compared to exBID and LIRA.ConclusionTreatment patterns varied among GLP-1 RA patients, with persistence highest among either LIRA or exQW across countries, and lowest among exBID. Longer-term data would be useful, particularly given limited exQW follow-up due to more recent launch.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-014-0087-6) contains supplementary material, which is available to authorized users.

Overall, expenditures in the HRP population are more than 10-fold higher compared with the full population. Managed care pharmacy can benefit from understanding what contributes to these higher costs, and managed care directors should consider an appropriately balanced assessment of the share of total spend by service and therapeutic category in HRP when devising drug usage and related cost-management strategies.

It still lags behind NICE's 2008 benchmark of 12%, in addition to uptake in other Western countries. We aimed to understand why the UK has comparatively low pump uptake. Methods: We performed a structured PubMed literature review using search terms "Continuous subcutaneous insulin infusion" AND glycaemi* OR hypoglycaemi* OR "costs and cost analysis[MeSH]", published after 01/01/2008. Captured articles were sifted; excluding irrelevant articles, or those not in English. Other relevant reports were captured by horizon scanning. Results: Our search terms captured 113 articles. Reviewing reports meeting the inclusion criteria revealed that since 2008, additional studies contribute evidence supporting CSII efficacy in improving HbA 1c , glycaemic variability and incidence of hypoglycaemia compared to MDI; in addition to being well-tolerated by patients. Recent cost-analyses suggest that CSII remains cost-effective, especially when increasing baseline HbA 1c , hypoglycaemia avoidance, or pump life expectancy. Furthermore, there may be a low availability of specialised nurses, dieticians and other clinicians that NICE recommends are required to form part of a CSII-specialised multi-disciplinary team. ConClusions: It is surprising that given the amount of evidence supporting the efficacy, safety and cost-effectiveness of CSII, uptake of pumps by T1DM patients remains low in the UK. It is interesting that current evidence may be undermined by poor availability of clinical staff specialised in CSII, thus preventing new patients from effectively managing their condition.

A453 patients using CSII and CGM; and 5)Results are more sensitive to reimbursement for routine physician care and lifestyle modification services. ConClusions: 1) Seven American professional societies comprising the Diabetes Working Group (DWG) concur delivering high-quality, guideline-based diabetes care unrealistic given current care and payment paradigms; 2) DWG recommends alternative approaches in 3 areas: care management, payment reform, and workforce supply, to mitigate increasing medical and financial impact of this epidemic chronic illness; 3) Model can be used internationally to support public policy efforts.

department anytime during 2010 and at least one readmission within 30 days were included. A multivariate marginal Cox model using clustering of admissions within patients was employed to test the association between DHR and LOS. Results: 16,922 readmitted patients with a total of 27,057 readmissions comprised the study's cohort. Of these, 2,015 (11.9%) had a DHR. Factors that were associated with DHRs: index hospital size (OR: 2.60 and 1.28 for small and medium hospitals, compared to large), younger age (age 18-44, OR= 1.7), being male (OR= 1.13) and long LOS (8+ days) in the index hospitalization (OR= 1.33). Residency in a nursing home and chronic conditions like COPD, Asthma, Disability and Alcohol were associated with a decreased likelihood of DHRs. The mean LOS in same-hospital readmissions was shorter by almost one day as compared with the mean LOS for DHRs, 6.1 (95% CI: 6.0-6.2) vs. 6.9 (95% CI: 6.6-7.2), respectively. One of the strongest predictors of longer LOS was DHR (HR= 0.88 p< 0.001). ConClusions: Adjusting to key confounders, when readmission is to a different-hospital than the index admission, there is increased average LOS. Such an outcome can signify breakdowns in continuity of care and a need to create more seamless care processes when patients are readmitted to a different hospital.