Between 1994 and 2007, the estimated number of yearly patient visits to treat diabetes increased from 25 million to 36 million. During the period reviewed by the study, the number of doctor visits in which only one drug was prescribed decreased from 82 percent to 47 percent, and the average number of medications prescribed per treated patient rose from 1.14 to 1.63.
By 2007, biguanides (54 percent of treatment visits) and glitazones (28 percent of visits) were leading therapeutic classes. Increasing use of glitazones, newer insulins, sitagliptin phosphate, and exenatide largely accounted for recent increases in the mean cost per prescription ($56 in 2001 to $76 in 2007) and aggregate drug expenditures ($6.7 billion in 2001 to $12.5 billion in 2007). Avandia and Actos are glitazones, by the way, and so perhaps expenditures may slow, given recent warnings.
The upshot: "Increasingly complex and costly diabetes treatments are being applied to an increasing population," the authors write. "The magnitude of these rapid changes raises concerns about whether these more costly therapies will result in proportionately improved outcomes" (here is the full study).
The report is the first to be published by members of the Health Services Research Network (HSRN), a consortium of US academics that conducts independent research. The authors used IMS Health data to analyze meds prescribed between 1994 and 2007 for all US office visits among patients 35 years and older with type 2 diabetes.
One of the four authors, Caleb Alexander, is a Robert Wood Johnson Faculty Scholar and is also supported by a career development award from the Agency for Healthcare Research and Quality. Randall Stafford was supported by a Mid-Career Mentoring Award from the National Heart, Lung, and Blood Institute. There were no conflicts disclosed.