67 - Superiority of Nasal Spray Compared to Orally Administered Metoclopramide in Reducing Healthcare Costs in Treating Diabetic Gastroparesis Patients
Richard McCallum, MD1, Michael Cline, DO2, Mostafa Shokoohi, PhD3, Sumaiya Marium, MSc3, Jonathan Kish, PhD3, David C.. Kunkel, MD4 1TTUHSC, El Paso, TX; 2Cleveland Clinic Foundation, Cleveland, OH; 3EVERSANA, Burlington, ON, Canada; 4UC San Diego Health, La Jolla, CA
Introduction: Diabetic gastroparesis (DGP) is a chronic disorder marked by significant morbidity and healthcare utilization. DGP patients experience 3x greater emergency department (ED) and inpatient hospitalization (IH) costs, and 2x greater hospital outpatient (HO) costs compared to patients with diabetes without GP. Nasal metoclopramide (NMCP) was approved in 2020 for acute and recurrent DGP. We sought to compare real-world healthcare costs (from a US, 3rd-party payer perspective) between patients treated with NMCP vs oral MCP (OMCP) to assess if an alternate route could improve outcomes.
Methods: NMCP and OMCP treated DGP patients were retrospectively identified in the IBM® MarketScan® Research Database. Patients ≥18 years dispensed NMCP or OMCP between June 2020 and December 2022, with ≥6 months of pre-index (dispense date) and post-index data were selected. Using the near-neighbor method of propensity score (PS) matching, 4 OMCP patients were selected for every 1 NMCP patient. Total costs (medical and pharmacy) during the 6 months following treatment initiation were calculated for each cohort along with total costs by setting of care: IH, ED, HO, physician office (PO), clinic, lab/home/telehealth (LHT). Mean differences in cost along with 95% confidence internal (CI) were obtained using Tweedie generalized linear model (GLM) with Gamma distribution and identity link.
Results: 45 NMCP patients were matched to 180 OMCP patients across demographic and disease severity, with standardized mean differences <0.10. NMCP-treated patients incurred lower cost across care sites: IH = -$10,021 (95%CI: -17,666, -2,376; p-value=.01), ED = -$926 (-1,371, -481; p-value< .001), HO= -$3,247 (-5,428, -1,066; p-value=.004), and LHT = -$472 (-846, -98; p-value =.014). Total medical cost (sum of all sites) was $16,808 (8,196, 25,420; p-value< .001) lower in the NMCP cohort. NMCP pharmacy cost was $1,581 (-1,269, 4,431) higher, but not statistically significant (p-value=0.276). Total healthcare cost was $15,227 lower in NMCP versus OMCP cohort (4,615, 25,839; p-value=.005).
Discussion: Total all-cause healthcare cost and specifically for inpatient, outpatient and ED visits were significantly reduced during the 6 months following treatment initiation with NMCP compared to OMCP confirming the superiority of the NMCP route for treating DGP patients. We observed similar results for DGP symptom-related outcomes.
Disclosures:
Richard McCallum: Evoke Pharma – Advisor or Review Panel Member.
Michael Cline: Evoke Pharma – Advisor or Review Panel Member.
Mostafa Shokoohi: EVERSANA – Employee.
Sumaiya Marium: EVERSANA – Employee.
Jonathan Kish: EVERSANA – Employee.
David Kunkel: Evoke Pharma – Consultant.
Richard McCallum, MD1, Michael Cline, DO2, Mostafa Shokoohi, PhD3, Sumaiya Marium, MSc3, Jonathan Kish, PhD3, David C.. Kunkel, MD4, 67, Superiority of Nasal Spray Compared to Orally Administered Metoclopramide in Reducing Healthcare Costs in Treating Diabetic Gastroparesis Patients, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
