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Confusion over oral diabetes treatments increases costs


A substantial proportion of patients initiating an oral hypoglycemic drug do not receive the recommended therapy. The potential savings from improved adherence to the recommendations could top $420 million annually.

Practice patterns of medication initiation in newly diagnosed diabetes mellitus have implications for healthcare spending, according to a study published in the American Journal of Medicine.

“A substantial proportion of patients initiating an oral hypoglycemic drug do not receive guideline recommended therapy,” says Niteesh K. Choudhry, MD, PhD, one of the study authors. “We found substantial variability in contemporary clinical practice for patients initiating drug therapy for diabetes.”

The study included a large group of managed care enrollees starting oral diabetes treatment and found that 35% of patients did not receive the recommended first-line drug. Further, the medication costs for this subgroup of patients comprised 66.3% of the total expenditures for hypoglycemic drugs in the entire cohort.

Nationally, with approximately 2 million new cases of diabetes each year, an excess expenditure of $1,120 per patient per year would translate to more than $420 million in additional direct medication costs for diabetes therapy outside established consensus recommendations, according to the researchers.

However, the prevalence of diabetes is increasing dramatically, so the potential savings from improved adherence to the recommendations could exceed the estimates.

Dr. Choudhry, who is also associate professor, Harvard Medical School, and associate physician, Division of Pharmacoepidemiology and Pharmacoeconomics and the Hospitalist Service, Brigham and Women's Hospital in Boston, says the results highlight a situation where recommended care, clinical efficacy, and cost-conscious prescribing are all aligned.

“Pharmacotherapy for diabetes presents a significant opportunity for quality and performance improvement initiatives and holds the potential to realize significant savings for patients, payers and the entire healthcare system.”

In the United States, more than 20 million individuals have diabetes, and an additional 6 million have undiagnosed disease. The number of Americans with diabetes is projected to increase 165% by 2050. In the United States, this disease alone accounts for nearly $200 billion in direct and indirect medical costs each year. Six different oral medication classes have been approved by FDA for the treatment of type 2 diabetes but only metformin and sulfonylurea are recommended as first-line therapy.

“Despite the widespread dissemination of professional society recommendations, little is known about current clinical practice patterns for patients who initiate an oral hypoglycemic agent,” Dr. Choudhry says. 

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