Cost of Diabetes Treatment Nearly Doubled Since 2001

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Source: University of Chicago Medical Center

Released: Thu 23-Oct-2008, 08:30 ET

Embargo expired: Mon 27-Oct-2008, 16:00 ET

http://www.newswise.com/articles/view/545667/?sc=rsmn

Cost of Diabetes Treatment Nearly Doubled Since 2001

Description

Because of the increased number of patients, growing reliance on

multiple medications and the shift toward more expensive new medicines,

the annual cost of diabetes drugs nearly doubled in only six years,

rising from $6.7 billion in 2001 to $12.5 billion in 2007. The single

greatest contributor was the use of newer, more expensive medications.

Newswise — Because of the increased number of patients, growing reliance

on multiple medications and the shift toward more expensive new

medicines, the annual cost of diabetes drugs nearly doubled in only six

years, rising from $6.7 billion in 2001 to $12.5 billion in 2007

according to a study in the Oct. 27, 2008, issue of the Archives of

Internal Medicine.

Since more then one-tenth of all health care expenditures in the United

States in 2002 were attributable to diabetes, this finding raises

important questions about whether the higher cost actually translates

into improved care.

" Although more patients and more medications per patient played a role,

the single greatest contributor to increasing costs is the use of newer,

more expensive medications, " said lead author Caleb , MD, MS,

assistant professor of medicine at the University of Chicago. " But new

drugs don't automatically lead to better outcomes. "

" Just because a drug is new or exploits a new mechanism does not mean

that it adds clinically to treating particular diseases, " said co-author

Randall Stafford, MD, PhD, associate professor at Stanford University

School of Medicine. " And even if a new drug does have a benefit, it's

important to consider whether that benefit is in proportion to the

increased cost. "

The researchers used two national data bases, one extending back to

1994, to assess trends in diabetes treatment. They found that the number

of Americans diagnosed with diabetes rose steadily from 10 million in

1994, to 14 million in 2000, to 19 million in 2007.

This rapid growth reflects trends in American eating habits and

behavior, the authors note, since the risk of developing type 2 diabetes

increases with age, obesity, and physical inactivity. " Part of the

increase is due to an increasingly sedentary lifestyle and increasing

caloric intake, " said Stafford.

At the same time, the average number of medications per patient has

increased from 1.06 medications per patient in 1994 to 1.45 medications

per patient in 2007. In 1994, 82 percent of patients were prescribed

only one drug; in 2007, only 47 percent were.

Meanwhile, the average price of a diabetes drug prescription increased

from $56 in 2001 to $76 in 2007, due in large part to the rapid uptake

of newly available oral medications, increasingly prescribed as

alternatives to injectable insulin.

In 2007, for example, new drugs such as sitagliptin (brand name Januvia,

$160 per average prescription) and exenatide (Byetta, $202) made up

eight percent and four percent, respectively, of all physician office

visits where a diabetes drug was prescribed. These drugs cost eight to

11 times more than older, generic drugs such as metformin or glypizide.

Although insulin use declined, the price per insulin prescription

increased as new and pricier preparations of long-acting and

ultrashort-acting insulins and their combinations gained popularity.

This diffusion of new therapies demonstrates the successful translation

of research from bench to bedside, the author note. But they add that

this study documents the rapid uptake of newer and more expensive drugs

whose long-term safety and cost-effectiveness in broader populations is

not known. " Without such long-term data, " said , " we cannot be

certain if the widespread use of the costlier drugs is balanced by

sufficient improvements in health. "

The study acknowledges that one indicator of benefit from diabetes

drugs, average levels of the hemoglobin A1c blood test, improved between

1999 and 2004. Hemoglobin A1c reflects the three-month average of blood

sugar and indicates how well this aspect of diabetes is being managed.

But short-term outcomes like better A1c levels don't prove that patients

with diabetes are actually benefiting from the new drugs in ways that

matter, said. " They may not always correlate with long-term

outcomes that people really care about, such as diabetes' impact on

heart and kidney function. "

Important long-term outcomes take many years to measure, Stafford said.

" What we need are larger population studies examining the relative

benefits of different drugs in treating diabetes and looking for these

outcomes in people followed over an extended time period. " As a model,

he pointed to the Women's Health Initiative, a federal study that

followed 162,000 women over 15 years to measure the effectiveness of

treatments for heart disease, osteoporosis, and cancer.

The Wood Foundation, the Agency for Healthcare Research

and Quality, and the National Heart Lung, and Blood Institute funded the

study. Additional authors include Moloney of the University of

Chicago and Niraj Seghal now at the University of California at San

Francisco.

--

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