S621 Superiority of Nasal Spray Compared to Orally Administered Metoclopramide in Reducing Healthcare Costs in Treating Diabetic Gastroparesis Patients
Bibliographic record
Abstract
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, third-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: Forty-five 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). Conclusion: 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".