• Jee H Choe, Si Xuan, Antony Goldenberg, Jacqueline Matian, Jeff McCombs, and Rory E Kim.
• Department of Pharmaceutical and Health Economics, USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, 635 Downey Way, VPD 414C, Los Angeles, CA 90089-3333. Email: jhchoe@usc.edu.
• Am J Manag Care. 2024 Apr 1; 30 (4): e124e134e124-e134.

ObjectivesMedication persistence in type 2 diabetes (T2D) is a critical factor for preventing adverse clinical events. We assessed persistence among newly treated patients with T2D and documented the impact of persistence on clinical outcomes and costs.Study DesignRetrospective study of Optum Clinformatics Data Mart commercial and Medicare Advantage enrollees from 2007 to 2020.MethodsWe identified adult patients who initiated antidiabetic treatments. Patients were required to have at least 1 treatment-free year prior to their first T2D prescription. Persistence was measured as the duration of continuous therapy until a 60-day gap in drug availability appeared in any antidiabetic therapy. Factors associated with duration were documented, focusing on the initial class(es) of T2D drugs. The impact of treatment duration on the risk of hospitalization and on total health care costs was also examined.ResultsA total of 673,265 patients were included, with a median follow-up of 7 years. Only 22% of patients maintained continuous treatment, of whom 10% added a second medication. A 1-month increase in duration was associated with reduced risk of hospitalization due to stroke by 0.54% (95% CI, 0.46%-0.60%), acute myocardial infarction by 0.51% (95% CI, 0.44%-0.57%), and all-cause hospitalization by 0.36% (95% CI, 0.34%-0.37%). A 1-month increase in duration was associated with a year-to-year decrease in medical costs of $51 (95% CI, -$54 to -$48) and an increase in year-to-year drug costs of $14 (95% CI, $13-$14).ConclusionsOur findings show low persistence among patients with T2D and emphasize the importance of medication persistence, which is associated with cost savings and lower risk of hospitalizations.

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