Abstract：
BACKGROUND: Type 2 diabetes (T2D) represents a remarkable disease burden in Japan, and the cost-effectiveness of pharmacotherapy is an important consideration. In this study, we compared the long-term effects of the type of initial medication, as well as the initial frequency of clinic visits, on the occurrence of T2D-related complications. Additionally, we compared the medical costs associated with each treatment pattern.
METHODS: We analyzed electronic health record data collected from multiple primary care clinics in Japan. Patients were selected based on being primarily prescribed either biguanides (BG) or DPP-4 inhibitors (DPP-4i) during a 3-month baseline period, both of which are commonly used as first-choice medications in Japan. We then followed the onset of T2D-related complications and conducted survival analyses. Additionally, we calculated the accumulated medical costs up to the onset of an event or loss to follow-up, and summarized the annual costs per patient for each treatment pattern.
RESULTS: A total of 416 Japanese patients with T2D who initiated treatment between January 2015 and September 2021 were included. The median follow-up period was 2.69 years. The survival analysis showed that the use of DPP-4is and frequent visits from the beginning of treatment did not offer a benefit in suppressing the onset of complications later on. On the other hand, it was found that the annual medical costs for the group using DPP-4i with frequent visits were about 1.9 times higher than for the group using BGs with less frequent visits.
CONCLUSIONS: The results suggest that for Japanese patients with T2D, the use of BGs along with relatively long follow-up intervals in the beginning of treatment can remarkably reduce medical costs while providing a level of complication suppression equivalent to that of the use of DPP-4is or frequent visits.
METHODS: We analyzed electronic health record data collected from multiple primary care clinics in Japan. Patients were selected based on being primarily prescribed either biguanides (BG) or DPP-4 inhibitors (DPP-4i) during a 3-month baseline period, both of which are commonly used as first-choice medications in Japan. We then followed the onset of T2D-related complications and conducted survival analyses. Additionally, we calculated the accumulated medical costs up to the onset of an event or loss to follow-up, and summarized the annual costs per patient for each treatment pattern.
RESULTS: A total of 416 Japanese patients with T2D who initiated treatment between January 2015 and September 2021 were included. The median follow-up period was 2.69 years. The survival analysis showed that the use of DPP-4is and frequent visits from the beginning of treatment did not offer a benefit in suppressing the onset of complications later on. On the other hand, it was found that the annual medical costs for the group using DPP-4i with frequent visits were about 1.9 times higher than for the group using BGs with less frequent visits.
CONCLUSIONS: The results suggest that for Japanese patients with T2D, the use of BGs along with relatively long follow-up intervals in the beginning of treatment can remarkably reduce medical costs while providing a level of complication suppression equivalent to that of the use of DPP-4is or frequent visits.
摘要：
背景：2型糖尿病（T2D）在日本代表了显着的疾病负担，药物治疗的成本效益是一个重要的考虑因素。在这项研究中,我们比较了初始药物类型的长期效果，以及最初的诊所就诊频率，关于T2D相关并发症的发生。此外,我们比较了与每种治疗模式相关的医疗费用.
方法：我们分析了从日本多个初级保健诊所收集的电子健康记录数据。选择患者的基础是在3个月的基线期间主要服用双胍（BG）或DPP-4抑制剂（DPP-4i）。在日本，这两种药物都是常用的首选药物。然后，我们追踪T2D相关并发症的发作并进行生存分析。此外,我们计算了事件发生或失去随访的累计医疗费用，并总结了每种治疗模式的每位患者的年度费用。
结果：共纳入了在2015年1月至2021年9月期间开始治疗的416例日本T2D患者。中位随访期为2.69年。生存分析表明，使用DPP-4和从治疗开始的频繁就诊并没有在抑制并发症的发生方面提供益处。另一方面,研究发现,频繁就诊的使用DPP-4i组的年度医疗费用比不频繁就诊的使用BG组的年度医疗费用高约1.9倍.
结论：结果表明，对于患有T2D的日本患者，在治疗开始时使用BG以及相对较长的随访间隔可以显着降低医疗成本,同时提供与使用DPP-4或频繁就诊相当的并发症抑制水平.
方法：我们分析了从日本多个初级保健诊所收集的电子健康记录数据。选择患者的基础是在3个月的基线期间主要服用双胍（BG）或DPP-4抑制剂（DPP-4i）。在日本，这两种药物都是常用的首选药物。然后，我们追踪T2D相关并发症的发作并进行生存分析。此外,我们计算了事件发生或失去随访的累计医疗费用，并总结了每种治疗模式的每位患者的年度费用。
结果：共纳入了在2015年1月至2021年9月期间开始治疗的416例日本T2D患者。中位随访期为2.69年。生存分析表明，使用DPP-4和从治疗开始的频繁就诊并没有在抑制并发症的发生方面提供益处。另一方面,研究发现,频繁就诊的使用DPP-4i组的年度医疗费用比不频繁就诊的使用BG组的年度医疗费用高约1.9倍.
结论：结果表明，对于患有T2D的日本患者，在治疗开始时使用BG以及相对较长的随访间隔可以显着降低医疗成本,同时提供与使用DPP-4或频繁就诊相当的并发症抑制水平.
