A Comparison of Inpatient Cost Per Day in General Surgery Patients with Type 2 Diabetes Treated with Basal-Bolus versus Sliding Scale Insulin Regimens.

• Type of Material: Article
• Authors: Victoria Phillips, Emory University; Anwar L. Byrd, Emory University; Saira Adeel, Emory University; Limin Peng, Emory University; Dawn Smiley-Byrd, Emory University; Guillermo Umpierrez, Emory University
• Language: English
• Date: 2017
• Publisher: Adis
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2017
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s41669-017-0020-9
• Title of Journal or Parent Work: PharmacoEconomics
• ISSN: 1170-7690
• Volume: 1
• Issue: 2
• Start Page: 109
• End Page: 115
• Grant/Funding Information: The sponsor had no input into the results presented here.; Dr Umpierrez is supported in part by research grants from the American Diabetes Association (7-03-CR-35) and PHS Grant UL1 RR025008 from the Clinical and Translational Science Award Program (M01 RR-00039), National Institutes of Health, National Center for Research Resources; Dr Umpierrez received grant support (to Emory University) from Merck, Sanofi, Boehringer Ingelheim, Astra Zeneca and Novo Nordisk.; This investigator-initiated study was supported by an unrestricted grant from Sanofi (Bridgewater, NJ, USA).
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

BACKGROUND: The identification of cost-effective glycaemic management strategies is critical to hospitals. Treatment with a basal-bolus insulin (BBI) regimen has been shown to result in better glycaemic control and fewer complications than sliding scale regular insulin (SSI) in general surgery patients with type 2 diabetes mellitus (T2DM), but the effect on costs is unknown. OBJECTIVE: We conducted a post hoc analysis of the RABBIT Surgery trial to examine whether total inpatient costs per day for general surgery patients with T2DM treated with BBI (n = 103) differed from those for patients with T2DM treated with SSI (n = 99) regimens. METHODS: Data were collected from patient clinical and hospital billing records. Charges were adjusted to reflect hospital costs. General linearized models were used to estimate the risk-adjusted effects of BBI versus SSI treatment on average total inpatient costs per day. RESULTS: Risk-adjusted average total inpatient costs per day were $US5404. Treatment with BBI compared with SSI reduced average total inpatient costs per day by $US751 (14%; 95% confidence interval [CI] 20-4). Being treated in a university medical centre, being African American or having a bowel procedure or higher-volume pharmacy use significantly reduced costs per day. CONCLUSIONS: In general surgery patients with T2DM, a BBI regimen significantly reduced average total hospital costs per day compared with an SSI regimen. BBI has been shown to improve outcomes in a randomized controlled trial. Those results, combined with our findings regarding savings, suggest that hospitals should consider adopting BBI regimens in patients with T2DM undergoing surgery.