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

Victoria L. Phillips (), Anwar L. Byrd, Saira Adeel, Limin Peng, Dawn D. Smiley and Guillermo E. Umpierrez
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Victoria L. Phillips: Rollins School of Public Health of Emory University
Anwar L. Byrd: Emory University School of Medicine
Saira Adeel: Emory University School of Medicine
Limin Peng: Rollins School of Public Health
Dawn D. Smiley: Emory University School of Medicine
Guillermo E. Umpierrez: Emory University School of Medicine

PharmacoEconomics - Open, 2017, vol. 1, issue 2, No 4, 109-115

Abstract: 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.

Keywords: Surgery Trial; Patient Health Status; General Surgery Patient; American Heart Association Classification; Slide Scale Insulin (search for similar items in EconPapers)
Date: 2017
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DOI: 10.1007/s41669-017-0020-9

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