Fiona I Imarhia1, Janeca N Malveaux1. 1. is a Clinical Pharmacy Specialist in Home Based Primary Care and is a Clinical Pharmacy Specialist in Primary Care, both at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas.
Abstract
PURPOSE: As a result of a cost savings initiative, the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, selected liraglutide as its preferred glucagon-like peptide 1 receptor agonist for the treatment of patients with type 2 diabetes mellitus with a preferred maximum daily dose of 1.2 mg. With this change, several veterans were converted from liraglutide 1.8 mg daily to 1.2 mg daily; however, the benefit of this change remains unknown. The objective of this study was to assess sustained glycemic control and cost savings that resulted from the liraglutide dose reduction. METHODS: A retrospective chart review was conducted to include veterans on liraglutide 1.8 mg daily and insulin and/or other antihyperglycemic agents who were converted to liraglutide 1.2 mg daily between May 2018 and August 2018. Demographic data, hemoglobin A1c (HbA1c), serum glucose levels, body weight, prescriber type, and medication history were obtained using the Computerized Patient Record System. Veterans' charts were evaluated over a 6-month evaluation period, and descriptive statistics and paired t tests were used to analyze results as appropriate. RESULTS: A total of 97 veterans were included. At the time of conversion, the average (SD) HbA1c was 8.2% (1.4), and body average (SD) weight was 116.2 kg (23.2). Six months after the dose conversion, average (SD) HbA1c increased to 8.7% (1.8) (95% CI, -0.76 to -0.22; P = .0005), and average (SD) body weight increased to 116.5 kg (24.6) (95% CI, -2.11 to 1.64; P = .8). To account for the HbA1c increase, 41.2% of veterans underwent an insulin dose increase, whereas 40.2% of veterans had no medication dose changes. An estimated annual cost savings of $230,922.72 resulted from the liraglutide dose reduction. CONCLUSIONS: Dose reduction of daily liraglutide treatment from 1.8 mg to 1.2 mg was associated with HbA1c increase, increased insulin requirements, and cost savings. A cost effectiveness analysis is needed to assess overall benefit of the liraglutide dose reduction initiative.
PURPOSE: As a result of a cost savings initiative, the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, selected liraglutide as its preferred glucagon-like peptide 1 receptor agonist for the treatment of patients with type 2 diabetes mellitus with a preferred maximum daily dose of 1.2 mg. With this change, several veterans were converted from liraglutide 1.8 mg daily to 1.2 mg daily; however, the benefit of this change remains unknown. The objective of this study was to assess sustained glycemic control and cost savings that resulted from the liraglutide dose reduction. METHODS: A retrospective chart review was conducted to include veterans on liraglutide 1.8 mg daily and insulin and/or other antihyperglycemic agents who were converted to liraglutide 1.2 mg daily between May 2018 and August 2018. Demographic data, hemoglobin A1c (HbA1c), serum glucose levels, body weight, prescriber type, and medication history were obtained using the Computerized Patient Record System. Veterans' charts were evaluated over a 6-month evaluation period, and descriptive statistics and paired t tests were used to analyze results as appropriate. RESULTS: A total of 97 veterans were included. At the time of conversion, the average (SD) HbA1c was 8.2% (1.4), and body average (SD) weight was 116.2 kg (23.2). Six months after the dose conversion, average (SD) HbA1c increased to 8.7% (1.8) (95% CI, -0.76 to -0.22; P = .0005), and average (SD) body weight increased to 116.5 kg (24.6) (95% CI, -2.11 to 1.64; P = .8). To account for the HbA1c increase, 41.2% of veterans underwent an insulin dose increase, whereas 40.2% of veterans had no medication dose changes. An estimated annual cost savings of $230,922.72 resulted from the liraglutide dose reduction. CONCLUSIONS: Dose reduction of daily liraglutide treatment from 1.8 mg to 1.2 mg was associated with HbA1c increase, increased insulin requirements, and cost savings. A cost effectiveness analysis is needed to assess overall benefit of the liraglutide dose reduction initiative.
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