AIM: Do better outcomes reflect doubling of diabetes costs?

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A dramatic increase in the annual cost of diabetes drugs in only six years has experts questioning whether the newer more expensive oral medications actually lead to better outcomes.

Due to an 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 from $6.7 billion in 2001 to $12.5 billion in 2007 according to a study in the Oct. 27 issue of the Archives of Internal Medicine.

Since more than one-tenth of all U.S. healthcare expenditures in 2002 were attributable to diabetes, the increase raises questions about whether higher drug costs actually translate into improved care.
The study documents the rapid adoption of newer and more expensive drugs whose long-term safety and cost-effectiveness in broader populations is not known.

"Without such long-term data, we cannot be certain if the widespread use of the costlier drugs is balanced by sufficient improvements in health,” said lead author Caleb Alexander, MD, assistant professor of medicine at the University of Chicago.

The number of Americans diagnosed with diabetes rose steadily, from 10 million in 1994 to 14 million in 2000, and to 19 million in 2007.

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, it was only 47 percent, according to the authors.

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 adoption of newly available oral medications, increasingly prescribed as alternatives to injectable insulin.

"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 in California. "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 Robert Wood Johnson Foundation, the Agency for Healthcare Research and Quality (AHRQ) and the National Heart Lung and Blood Institute funded the study.