816-P: Health Care Resource Utilization and Costs with Timely vs. Delayed Basal Insulin Initiation

Introduction & Objective: Many patients with uncontrolled type 2 diabetes (uT2D) on other glucose-lowering medications (GLMs) eventually require basal insulin, but initiation is often delayed. This study assessed the potential impact of the timing of insulin initiation by examining healthcare utilization and costs among patients with timely vs delayed basal insulin initiation.

Methods: In the 2011-2018 Merative^TM Claims-EHR Database, adults with uT2D who were candidates for basal insulin (HbA1c>7%, ≥2 GLMs totaling ≥180 days’ supply, no new GLM class in the next 90 days) and newly initiated treatment were selected. The index date was the first basal insulin fill. Timely and delayed initiators started treatment <6 months and ≥6 months after meeting criteria for uT2D, respectively. Patients had ≥12 months of pre- and post-enrollment, no claims for type 1 diabetes or pregnancy, and ≥1 claim for T2D. All-cause healthcare utilization and costs were compared between cohorts in the pre- and post-periods.

Results: This study included 1,054 (29.2%) timely and 2,561 (70.8%) delayed initiators. Prior to basal insulin initiation, timely initiators had greater use of inpatient and emergency services, and significantly higher total costs ($26,460±$60,743 vs $21,703±38,825, p<0.01) and mean HbA1c (9.3±1.8 vs 8.9±1.5, p<0.001) compared to delayed initiators. Following treatment, both cohorts had similar utilization, costs and HbA1c values. Total costs from the pre- to post-period decreased in the timely initiator cohort (-$827) despite higher initial costs but increased in the delayed initiator cohort ($4,788).

Conclusion: Given the chronic nature of T2D, decreases in total costs over the study period among timely initiators highlighted the potential benefits of prompt basal insulin initiation for containment of healthcare costs. The same economic benefits were not observed among delayed initiators whose costs increased 22% in the post-period.