Is The Insulin Pen Mightier Than The Syringe?
Is the Insulin Pen Mightier Than the Syringe? Is the Insulin Pen Mightier Than the Syringe? Nonadherence to antidiabetic therapies represents a major challenge to clinicians treating patients with diabetes. Adherence rates range from 62% to 64% for patients with type 2 diabetes mellitus (T2DM) taking insulin therapy .1 Barriers to adherence include "complicated regimens, fear of injection pain, social embarrassment, lack of confidence about self-injection, perception of injectable therapy as inconvenient, and belief that insulin use is the last resort."2 Additional barriers to adherence are patients' fears about insulin-induced hypoglycemia3 and physicians' delay of initiation of insulin therapy, due to concerns about nonadherence.4 Improving adherence to medication regimens is critical, as nonadherence leads to poorer glycemic control and increased risk of diabetic complications.2 POLL: Which Are Better: Syringes, or Insulin Pens? Vote Now! Moreover, greater medication adherence has been found to be associated not only with improved glycemic control but also with decreased health care utilization.5 Therefore, it is important to examine the most effective means of increasing adherence in patients with T2DM. Insulin pen devices incorporate the insulin and syringe in a single unit and have been found to address some of the barriers to adherence, as compared to conventional vials/syringes.2 Reasons that patients prefer pen devices include that they are easier to use, are more discrete, and elicit less fear in terms of self-injection.2 Additionally, pens may have greater dosing accuracy, compared with vials and syringes.2 Several observational studies have found greater adherence with insulin pens than with vials/syringes.6,7,8,9 Although insulin pens are associated with h Continue reading >>
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Insulin Is Too Expensive For Many Of My Patients. It Doesn't Have To Be.
At age 15, I developed an unquenchable thirst and frequent urination, and lost 20 pounds. I had developed Type 1 diabetes, an autoimmune disease that destroyed my body's ability to produce insulin. Without insulin, I would have eventually developed a condition called diabetic ketoacidosis, which is lethal without (and even sometimes with) treatment. Years later, I'm a practicing endocrinologist. I could never have imagined back when I first started taking insulin that one day I would have so many patients who could not afford the medication because of skyrocketing prices. When the drug was discovered in 1921, the original patent was sold to the University of Toronto for $1 so that no one else could patent it and "secure a profitable monopoly." Numerous improvements later, insulin is produced by a three-company oligopoly. When the first of the newer insulin "analogs," Humalog, hit the market in 1996, it sold for $21 a vial. Today, vials of analog insulins, including Humalog, sell for about $300. Patients with Type 1 diabetes typically require two or three vials of insulin per month, but patients who are more resistant to insulin, such as those with Type 2 diabetes, may require six or more. A recent paper in the Journal of the American Medical Association found that insulin nearly tripled in cost from 2002 to 2013. A lawsuit filed in January accuses insulin companies of price collusion for allegedly raising prices repeatedly and in lockstep to match their competitors. Prices have gotten so bad that the American Diabetes Association recently launched an online petition at MakeInsulinAffordable.org, which has been signed by more than 248,000 people. Because insulin is so expensive, some people take less than their prescribed dose, causing higher blood sugars, which may lead Continue reading >>
Patient Satisfaction And Cost-savings Observed With Insulin Pens In A Hospital Setting
Patient Satisfaction and Cost-savings Observed with Insulin Pens in a Hospital Setting A prospective, randomized, con A prospective, randomized, controlled, pilot study was conducted to evaluate the use of insulin pens compared to conventional vials and syringes in patients with Type I or Type II diabetes reliant upon subcutaneous insulin injections during hospitalization on two general medical-surgical units. The purpose of this study was to evaluate the outcomes and cost-savings associated with prefilled, disposable insulin pens compared to conventional insulin vial/syringe use in hospitalized patients with diabetes. All subjects were followed to determine extent of glucose control achieved with insulin while hospitalized. Prior to discharge, patients completed a survey regarding their satisfaction with the method in which insulin was administered. Patients were given a follow-up, telephone survey approximately 4 weeks after discharge to determine home insulin use. Cost-savings were determined during the study period based on the average wholesale price of insulin vials/syringes or pens. A total of 75 patients were enrolled in the two groups (40 control, conventional vial/syringe; 35 insulin pen). There were no significant differences between admit and discharge blood glucose levels or hypoglycemic and hyperglycemic events between the two groups. Significantly more patients prepared or [ldquo]dialed[rdquo] up their own dose (p[lt]0.005) of insulin, as well as self-injected their insulin dose using insulin pens during hospitalization (p= 0.001). Patients in the insulin pen group were significantly more satisfied with multiple aspects of their insulin experience during their hospitalization (p[lt]0.001). A significant savings of US $40 per patient was determined if insu Continue reading >>
Insulin Vials Vs. Insulin Cartridges: Further Cost Considerations
Go to: 1. Introduction Diabetes is difficult to control and treatment involves several approaches which are associated with different costs. In the Royal Medical Services (RMS), after diagnosis of the disease and by excluding the regular visits to the clinics, the core costs incurred by the RMS in diabetes treatment can be confined to the cost of medications dispensed to patients and hospitalization due to diabetes complications. Many patients need insulin in the regimen of diabetes treatment. For outpatients, insulin can be administered by two main approaches: traditional vials and cartridges. In the RMS, both approaches are available; however, it is believed that adopting one of these approaches could be more cost-effective from the RMS perspective. Both types of insulin packages contain 100 IU/ml of biphasic insulin aspart. The vial contains 10 ml (1000 IU), while the cartridge used to refill the pen contains 3 ml (300 IU). Although, it is assumed that both approaches produce the same pharmacological outcomes, the ease of use and patient adherence have been compared widely in the literature (Baser et al., 2010; Bohannon, 1999; Rakel, 2009). The comparison between these approaches strongly favors the use of cartridges due to many reasons, for example, pens provide more accurate dosing, less pain due to smaller needle gauge, increased social acceptability and better quality of life (Bohannon, 1999); moreover, patient adherence was improved by using pens without significant increase in the cost (Baser et al., 2010). A study conducted in Mayo Clinic found that converting patients to insulin pens provided an overall cost savings (Ward and Aton, 2011). Another study, in the USA, found that overall annual health care costs were significantly decreased by starting or convert Continue reading >>
The Cost Of Insulin
The price of insulin has more than tripled in ten years. Not everybody pays full price, but many find the cost of insulin complicates their life. This week, we’ll cover why insulin prices are so high. Next week, we’ll address what to do about it. According to this story on CBS News, people with diabetes are “cutting back [on their insulin doses] or even going without the drug,” putting them at greater risk for complications. Insulin costs have soared from $100–$200 per month a few years ago to $400–$500 a month now. CBS News quotes a college student saying her bill for insulin has risen from $130 to $495 per month. She has given up her insulin pump and gone back to injections because of expense. One of her friends has cut her dose down to 80% of what’s ordered to save money. This has become common practice for many. A doctor in Montana reported that insulin prices greatly complicate people’s care. “I have patients who tell me that they have to make a decision between food and insulin, and their rent and insulin.” Why is this happening? When insulin was discovered the 1920s, the doctors who found it gave it away. It immediately started saving lives for people with Type 1 diabetes. Now insulin has become a $24-billion-a-year market globally and is predicted to pass $48 billion in only five more years. And people around the world who need it can’t afford it. There are several causes for the price spikes, but many of them come down to America’s pretend “free market” approach to health care. We are seeing these problems now with the controversy over one brand of epinephrine injections, whose manufacturer increased their price by 500% and then paid their CEO a nearly $19 million salary. Here are some ways American economics are making insulin unaff Continue reading >>
Pens Versus Vials For Insulin Delivery: A Cost Comparison
San Francisco—Diabetes mellitus (DM) is the leading cause of kidney failure, nontrauma-related amputation of lower limbs, and new cases of blindness in the United States; it is also one of the most common causes of heart disease, stroke, and death. Type 2 DM (T2DM) is the most common form of the disease, affecting up to 7.9% of the US population. Estimated associated healthcare costs are $159.5 billion each year. Treatment guidelines emphasize the correct type of insulin at the correct time; according to researchers, the method used to deliver the insulin may also have an impact on patient outcomes. Previous studies have shown that patients prefer using an insulin pen rather than the traditional syringe and vial. __________________________________________________________________________________________________________________ RELATED CONTENT Over-the-Counter Insulin Available for Patients with Diabetes Who Cannot Afford Prescription U.S. FDA approves Medtronic's 'artificial pancreas' for diabetes ___________________________________________________________________________________________________________________ Researchers recently conducted a retrospective analysis to compare total direct healthcare charges and diabetes-related total direct healthcare charges among adults with T2DM who initiate therapy with mealtime insulin disposable pens or vials. They reported results of the analysis at a poster session at the AMCP meeting. The poster was titled The Association Between Use of Mealtime Insulin Pens versus Vials and Healthcare Charges in Patients with Type 2 Diabetes. The analysis compared the insurance claims of a nationwide sample of adults who initiated mealtime analog insulin therapy with a prefilled pen or conventional syringe and vial to assess the impact of th Continue reading >>
Improved Disposable Insulin Pen Devices Provide An Alternative To Vials And Syringes For Insulin Administration
The prevalence of diabetes has increased so rapidly during the past 30 years that the condition is now a problem of national importance in the United States. It has been estimated that 12.3% of individuals aged 20–79 years in the United States (26.8 million people) have diabetes, and the vast majority of those have type 2 diabetes.1 Diabetes has devastating effects on patient morbidity and mortality that, in turn, place a substantial economic burden on the nation's health care resources. In 2010, an estimated 231,000 deaths among people aged 20–79 years in the United States were attributable to diabetes, and the mean annual health expenditure per person with diabetes was $7,383.1 Morbidity and mortality and the associated costs of treatment in diabetes are primarily due to hyperglycemia; achieving and maintaining optimal glycemic control is important for both patients with type 1 diabetes and those with type 2 diabetes to reduce the risk of developing long-term complications.2,3 Typically, in patients with type 1 diabetes, glycemic control is achieved from the time of diagnosis with insulin, whereas in type 2 diabetes, the addition of insulin to an initial regimen of oral antidiabetes drugs (OADs) is known to confer benefits in terms of reduced risk of long-term complications.4 However, although the importance of maintaining optimal glycemic control in diabetes is well documented, insulin therapy is widely underused in the United States,5 largely because a number of barriers to initiation of and adherence to insulin therapy exist such as fear of injections (including self-injection).6,7 Insulin pen delivery devices such as the SoloSTAR (sanofi-aventis, Paris, France), the FlexPen (Novo Nordisk A/S, Bagsvaerd, Denmark), and the KwikPen (Eli Lilly, Indianapolis, Ind.) Continue reading >>
Insulin Pens Vs. Vials And Syringes: Differences In Clinical And Economic Outcomes.
Abstract Insulin therapy is crucial to the treatment of many patients with diabetes mellitus. Therefore, it is important for pharmacists to consider the clinical and economic implications of the decision between insulin pens and insulin vials and syringes. Clinically, insulin pens show an advantage through improved adherence and reduced hypoglycemic events. Furthermore, overall health care costs were either unchanged or improved in insulin pen users as compared with those using insulin vials and syringes, although little economic advantage was observed when switching from insulin vials to insulin pens. Patients tend to prefer insulin pen use based on patient satisfaction and ease of use. Through an understanding of the advantages and disadvantages of insulin pens and vials and syringes, pharmacists can help to advocate for the most appropriate insulin-delivery method to maximize clinical outcomes and to reduce overall health care spending. Continue reading >>
Patient Satisfaction And Costs Associated With Insulin Administered By Pen Device Or Syringe During Hospitalization
Purpose: Patient satisfaction, safety and efficacy outcomes, and cost savings with insulin pens versus conventional insulin delivery via vials and syringes in hospitalized patients with diabetes were compared. Methods: Patients were recruited from two general medicalsurgical units from July 2005 to May 2006. Patients completed a survey regarding satisfaction with the method in which insulin was administered before discharge. Patients completed a telephone survey approximately four weeks after discharge to determine home insulin use. Cost savings were determined using the average wholesale price of insulin vials and syringes, pens, and pen needles. Results: A total of 94 patients were randomized to receive insulin administered via pen devices (n = 49) or using conventional vials and syringes (n = 45). Significantly more subjects in the pen group prepared or self-injected at least one dose of insulin during hospitalization, wanted to continue taking insulin at home using the method used during hospitalization, and would recommend their method of insulin administration used during hospitalization to other patients with diabetes compared with the vial and syringe group (p < 0.05). A cost saving of $36 per patient was projected if only insulin pens were dispensed during the entire hospital stay compared to insulin vials and syringes (p < 0.05). Conclusion: Increased patient satisfaction and continuation of the method of insulin administration used in the hospital at home were reported by patients who received insulin pens compared with patients who received conventional vials and syringes during hospitalization. A substantial cost saving was projected for patients in the insulin pen group if insulin pens had been dispensed during their entire hospital stay. Improvements in Continue reading >>
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Insulin Pens: Improving Adherence And Reducing Costs
The advantages offered by insulin pens may help improve patient adherence. Currently 8.3% of the United States adult population, or 25.8 million people, have diabetes. Of these cases, more than 90% are cases of type 2 diabetes mellitus (T2DM) and at least 1 million are estimated to be cases of type 1 diabetes mellitus (T1DM). Although a variety of oral medications are available for patients with diabetes, insulins remain an important component of treatment.1,2 Insulins are the standard therapy in patients with T1DM and are ultimately used in patients with T2DM who do not respond adequately to other treatment modalities. Although in some settings insulins may be administered intravenously (eg, with an insulin pump), the vast majority of insulin administrations are subcutaneous injections.1,2 Available Forms and Administration In the United States, 2 types of insulins are available: recombinant human insulins and insulin analogs. Recombinant human insulin is available from 2 manufacturers (Humulin by Eli Lilly and Novolin by Novo Nordisk); each of these is available in a regular form and in a longer-acting neutral protamine hagedorn (NPH) form. Unlike recombinant human insulins, insulin analogs are structurally modified forms of insulin that are designed to either lower blood sugar rapidly or maintain low blood sugar levels over time. These insulin analogs may be classified as rapid-acting and long-acting insulins. Rapid-acting insulins include insulin lispro, insulin aspart, and insulin glulisine, and long-acting insulins include insulin glargine and insulin detemir. Premixed formulations of insulin are also available.1,2 Regardless of the differences between insulin formulations, all conventional types of insulin can be administered subcutaneously. Subcutaneous injectio Continue reading >>
Pen Vs. Vial-and-syringe: Which Do Patients Prefer?
Early insulin treatment can help but many type 2 patients are still reluctant to start therapy…. This study was designed to evaluate patient preferences on insulin delivery, as well as health care professionals, as their recommendations can influence the decisions patients make on their diabetes management. A randomized, multicenter crossover, open-label study was conducted in 60 centers across the United States. A total of 405 patients participated in a 4 week crossover period and were randomized to receive basal insulin glargine via a SoloSTAR pen device or a vial and syringe for 2 weeks, and then switched to the other delivery device for the second 2 weeks. Preference for insulin delivery method among patients was obtained through an Insulin Injection Preference Questionnaire, which uses a 5 point scoring scale (1 = not preferred, 5 = preferred). A similar questionnaire was given to 135 health care professionals to complete. The results of the questionnaire showed that 85.3% of patients gave a score of 5 to the insulin pen compared to 7.5% of patients giving the vial and syringe a 5 score. In the health care professional questionnaire, 85.2% gave the highest score for the pen delivery method compared to 3% for the vial and syringe. In conclusion, insulin pens are preferred by both patients and health care professionals. They seem to find the pens easier to handle and more accurate in insulin dosage delivery. Patients also find insulin pens easier to use in public. This study supports previous studies conducted that demonstrated patients’ preferences of insulin pens over vial and syringe, which cite improved adherence, lower instances of hypoglycemia, and comparable clinical efficacy as reasons to use the insulin pen. Ahmann, S. et al. "Comparing Patient Preferenc Continue reading >>
Grudge Match: Pens Vs. Syringes
Taking insulin is a cornerstone of care for millions who have diabetes, and the most common method of insulin delivery in the U.S. is injection via needle and syringe. Roughly 20% of insulin users wear an insulin pump, 15% use insulin pens, and less than 1% use jet injectors. Insulin pumps can be expensive, with the average price hovering around $6,500, not including the disposable supplies that have to be replenished regularly, such as infusion sets, cartridges, and batteries. Although jet injectors may seem like a dream come true for patients who fear needles, they have been known to cause bruising and more pain than injections. The big question is why insulin pens are not more popular in the U.S., whereas in Europe and Japan, they comprise from 66% to 75% of insulin prescriptions. It’s not for lack of patient appreciation: In the November 2011 issue of the Journal of Diabetes Science and Technology, a review of 43 studies that compared patient- reported outcomes for insulin pen devices found that patients preferred pens over vial and syringe for myriad reasons, including ease of use, less pain, and greater perceived social acceptance. Indeed, patients are generally receptive to pen use — if their physicians bring it up. A study published in the March 2008 issue of Diabetes Care found that physician encouragement had a tremendous impact on pen use: Patients whose physicians discussed insulin pens were 100 times more likely to use an insulin pen than those whose physicians did not discuss pen use or who discouraged pen use. One reason pens have not caught on here may be payer reimbursement, says Maria J. Redondo, MD, PhD, MPH, assistant professor of pediatrics at Baylor College of Medicine in Houston and co-author of the 43-study review. “Pens are more expensive Continue reading >>
Assessment Of Adherence And Healthcare Costs Of Insulin Device (flexpen) Versus Conventional Vial/syringe
, Volume 27, Issue2 , pp 94104 | Cite as Assessment of adherence and healthcare costs of insulin device (FlexPen) versus conventional vial/syringe Diabetes is difficult to manage and treatment involves significant lifestyle adjustments. Unlike the traditional method of insulin administration via the vial and syringe method, insulin pens might be perceived as less cumbersome and have potential to significantly increase patient adherence. Using real world data, we examined the differences in adherence and costs between diabetic patients using an insulin FlexPen (Novo Nordisk Inc, Princeton, NJ, USA) and those using traditional vial and syringe administration. Using a retrospective analysis of health insurance claims data between the years 2003 and 2008, we examined patients in the FlexPen cohort and analog vial cohort. Propensity score matching was used to match these cohorts (n=532 in each) according to baseline characteristics. Adjusted mean medication possession ratio when switched to FlexPen improved by 22 percentage points versus 13 percentage points when continuing to use vials (P=0.001). Diabetes-related healthcare costs when switched to FlexPen versus continuing on to use vials ($3970 vs. $4838, respectively, P=0.9368) and total healthcare costs ($13,214 vs. $13,212, respectively, P=0.9473) were not statistically different. Without significant addition to the cost, insulin administration with FlexPen is associated with an improved adherence among patients who switched from vial-based insulin administration. adherencecostsFlexPeninsulinreal worldsyringe This is a preview of subscription content, log in to check access Unable to display preview. Download preview PDF. Gonder-Frederick L, Cox D, Ritterband L. Diabetes and behavioral medicine: the second decade. J Con Continue reading >>
Why Is Insulin So Expensive In The U.s.?
Dr. Jeremy Greene sees a lot of patients with diabetes that's out of control. In fact, he says, sometimes their blood sugar is "so high that you can't even record the number on their glucometer." Greene, a professor of medicine and history of medicine at Johns Hopkins University, started asking patients at his clinic in Baltimore why they had so much trouble keeping their blood sugar stable. He was shocked by their answer: the high cost of insulin. Greene decided to call some local pharmacies, to ask about low-cost options. He was told no such options existed. "Only then did I realize there is no such thing as generic insulin in the United States in the year 2015," he says. Greene wondered why that was the case. Why was a medicine more than 90 years old so expensive? He started looking into the history of insulin, and has published a paper about his findings in this week's issue of the New England Journal of Medicine. The story of insulin, it turns out, starts back in the late 1800s. That's when scientists discovered a link between diabetes and damaged cells in the pancreas — cells that produce insulin. In the early 1920s, researchers in Toronto extracted insulin from cattle pancreases and gave it to people who had diabetes, as part of a clinical trial. The first patient was a 14-year-old boy, who made a dramatic recovery. Most others recovered as well. Soon, insulin from pigs and cattle was being produced and sold on a massive scale around the world. But for some, the early forms of the medicine weren't ideal. Many people required multiple injections every day, and some developed minor allergic reactions. Over the next few decades, scientists figured out how to produce higher-quality insulin, Greene says. They made the drug purer, so recipients had fewer bad reaction Continue reading >>
How To Get Insulin At A Cheaper Price
Insulin can be expensive. If you’re one of the 6 million Americans with diabetes relying on this main-stay treatment, you could be paying out-of-pocket costs anywhere from $120 to $400 per month, according to a 2015 New England Journal of Medicine commentary. Drugs such as Lantus (insulin glargine) and Levemir (insulin detemir) have seen significant cost increases, according to a recent trend report by pharmacy benefit manager Express Scripts. One reason for the high prices is the lack of generic options for insulin. So for now, you’re stuck having to search around to find affordable options. Where do you shop for more affordable insulin? For some people though, high drug costs can mean making difficult financial choices. Our national polls show people might cut back on groceries and paying bills to pay for their medications. To minimize your costs, consider these options: Prescription Assistance Programs If you don’t have health insurance or are without drug coverage, look into applying for a patient assistance program (PAP). Through the nonprofit NeedyMeds, you can find some programs that offer free or low-cost insulin as long as you meet the eligibility requirements. Those are usually based on your insurance status, income, and diagnosis. You might also qualify for a diagnosis-specific program that can help you save on syringes, pumps, and other diabetes supplies. Pharmacists are also a great resource and can help you find a PAP that meets your financial needs. Switch Drugs Another way to save is by asking your doctor whether there’s a lower-priced insulin that’s right for you. While “long-acting” is a more popular type of insulin, it's also more expensive, but that doesn’t necessarily mean it works better. “It’s mostly a marketing ploy,” says M Continue reading >>