Case Study 2. In Case study 2, there was a moderate-large amount of missing data that ranged from 5% to 45% for individual variables. The study had 1,094 patients who met the inclusion and exclusion criteria; however, only 585 (53.5% of the original sample) patients had complete data for analysis. Multiple linear regression was performed to evaluated the association between GLP-1 agonists and reduction in HbA1c levels controlling for age, gender, race, baseline HbA1c, BMI, CCI, history of myocardial infarction, congestive heart failure, hypertension, obesity, and dyslipidemia. Complete-case analysis and multiple imputation method were performed and the results were compared to the crude analysis. In all three methods, there were no significant association between exenatide and reduction in HbA1c relative to liraglutide. Multiple imputation method provided the same conclusion as the complete-case analysis and crude analysis.
Case Study 2. In Case study 2, patients who were prescribed exenatide had no significant association with change in HbA1c compared to liraglutide while controlling for potential confounders. In contrast, Xxxx, et al.78 reported that liraglutide once daily had a significantly greater reduction in HbA1c compared with exenatide twice daily in a 26-week, open-labeled, parallel group, multinational study [-1.12% (SE, 0.08) versus -0.79% (0.08), P<0.0001]. The small sample size of the liraglutide cohort may reflect confounding by indication which is a form of selection bias.79 It is plausible that patients who were prescribed liraglutide may have some other indication than diabetes that is different from exenatide patients. The VHA national formulary does not include GLP-1 agonists. However, during the study period of interest, exenatide twice daily had a criteria for use document that formulary managers in the VHA used to determine whether or not the patient is eligible to receive the liraglutide based on specific criteria; liraglutide did not (xxxx://xxx.xxx.xx.xxx). Therefore, it is speculated, that providers and pharmacists preferred to use exenatide as a consequence of formulary guidelines being available. This may indicate that patients on lirgalutide could have been approved based on a specific clinical indication (other than diabetes) that would prevent them from using exenatide (e.g., previous history of exenatide, contraindication, or patient/provider preferences). Future studies will need to randomize exenatide and liraglutide to diabetic patients based on baseline HbA1c in order to reduce bias and potential confounding. Regardless, multiple imputation provided similar conclusions as the complete-case analysis and crude analysis. The confidence limit from the multiple imputation method was narrower compared to the complete-case analysis and crude analysis; however, this improvement in precision did not change the conclusion that there was no significant association between exenatide and change in HbA1c compared to liraglutide. In addition, multiple imputation provided benefit by increasing the sample size of the small cohort of liraglutide patients.
Case Study 2. The First Harvest
Case Study 2. Oxycodone 10mg modified release tablet (8386J) Maximum Price to Concessional Patients $6.60 $6.60 Maximum Price to General Patients $39.92 $41.00
Case Study 2. Xxxxxx, a 27 year old male, works in a mine outside of town, and comes home for a long weekend each month. He is single, and reports meeting up with women on his long weekends. He has 2 women he regularly reconnects with at a local bar when he is back in town. He presents to the health facility today because he has had a persistent cough that will not go away. His mother worriers he has pneumonia, and asked him to see a doctor before returning to the mine. Otherwise, he feels fine. Xxxxxx’s TB and HIV tests are positive. Sibongile, a 22 year old female, works as a hair dresser. She is married with a three year old child at home. Her husband is her only reported sex partner, since they married four years ago. She received an HIV testing during ANC with her first child, and was HIV-negative. She presents to the clinic today with nausea and fatigue, and would like a pregnancy test. Otherwise, she feels fine. Sibongile’s pregnancy and HIV tests are positive. Xxxxx, a 36 year old female, is a single mother. Her children are 14, 11 and 7 years old. She lost her job two years ago after her husband died. She finds small jobs here and there, and has been selling sex when money is too little to pay the bills. She has two male partners she sees regularly, one from church, and one from her neighborhood. She came today for an HIV test after hearing an advertisement on the radio about the importance of knowing your HIV status. She feels fine, but would like to know her HIV status for peace of mind. Xxxxx’ HIV test is positive. Xxxxxx, a 4-year old boy, presents to the outpatient department (OPD) at a health center today with his mother. He has had a cold for the past week. The intake counsellor asks his mother 4 questions:
