Using national patient-level claims data, this report analyzes physician adherence to the treatment guidelines by exploring the use of key therapies in the newly diagnosed and recently treated patient populations. Considering newly diagnosed patients, the report provides a quantitative analysis of treatment patterns and share by line of therapy, as well as progression between lines, duration of treatment on each line, and use of concomitant treatment. With respect to recently treated patients, the report quantifies a drug’s source of business compared with its competitors and details which drugs precede others through an analysis of add-versus-switch patterns. Additional analyses explore persistency and compliance by brand.

Questions Answered in This Report:

    • Newly diagnosed patients: What percentage of patients progress to a second- or third-line drug within the first year? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?
    • Recently treated patients: Which specific drugs garner the most patient share for recently treated patients? When do patients progress from one therapy to the next, and how does this pattern differ among key drugs? Are most recently treated patients with each key brand coming from new (adds/switches) or continuing business?
    • Pathways to key therapies: Which therapies have experienced market growth or decline over the key therapy periods studied? To what extent are key therapies prescribed concomitantly to recently treated patients? What has been the impact of recently approved drugs?

Scope:

Primary patient-level data: This report provides quantitative findings from our analysis of data covering approximately 40 million lives and provides the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. This report is delivered as a key findings slide deck, and presents claims that are between 6-12 months old at time of publication.

Patient Sample: To qualify for inclusion, patients had to be older than age 18 and meet one of the following conditions:

  • At least one prescription from the drug list and at least one claim with a diagnosis code for type 2 diabetes (T2D) (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 250.00, 250.02, 250.10, 250.12, 250.20, 250.22, 250.30, 250.32, 250.40, 250.42, 250.50, 250.52, 250.60, 250.62, 250.70, 250.72, 250.80, 250.82, 250.90, 250.92) during the study period.
  • At least two claims with a diagnosis code for T2D (see above) in the two-year period (the two claims must be 30 days apart).
  • At least one claim with a diagnosis code for T2D (see above) and at least two laboratory codes for a HbA1c test (CPT 83036) in the second year of this period only.
  • At least one prescription for an oral antidiabetic agent (OAA) and one prescription for either insulin or Symlin irrespective of ICD-9 diagnosis codes.
  • At least one claim with any of the above diagnosis codes for T2D in the two-year period and at least two claims for a fasting glucose test (CPT 82947).
  • At least one claim with any of the above diagnosis codes for T2D in the two-year period and at least two claims for a diabetes screening test (G8777).


Of these patients, those aged 18-40 who had at least one prescription for insulin or Symlin without an accompanying prescription for an OAA were excluded because these patients were considered likely to have type 1 diabetes (T1D). Although T1D patients older than age 40 could be captured in our analysis, we strongly believe that the vast majority of sampled patients are accurately diagnosed with T2D.

Quantified lines of therapy analyses show exact share of each agent in each line of therapy, including rate of progression between lines and length of time patients are on each line.

Newly diagnosed patients:

  • Patient share by drug class and key products across three lines of therapy, within one year of diagnosis.
  • Patient flowcharts through one year of treatment for all first-line products, including progression rates and add/switch behavior.
  • Polypharmacy and key concomitant therapies by line of therapy.
  • Quarterly trending of patient share by line of therapy.


Recently treated patients:

  • Quarterly snapshot of patient share by drug class and key products.
  • Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies, including add/switch behavior.
  • Brand source of business including share for continuing, new (switches/adds), and new (initial therapy) business.
  • Polypharmacy and key concomitant therapies.
  • Drug persistence and compliance.
  • Quarterly trends in patient share for all key therapies.

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