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- Title
Trends in Use of High-Cost Antihyperglycemic Drugs Among US Adults with Type 2 Diabetes.
- Authors
Le, Phuc; Bui, Thanh C.; Abramowitz, Joelle; Herman, William H.; Misra-Hebert, Anita D.; Rothberg, Michael B.
- Abstract
Background: Some antihyperglycemic drugs can reduce cardiovascular events, slow the progression of kidney disease, and prevent death, but they are more expensive than older drugs. Objectives: (1) To estimate trends in use of antihyperglycemic drugs by cost; (2) to examine use of high-cost drugs by race/ethnicity, income, and insurance status Design: Cross-sectional analysis of the 2003–2018 National Health and Nutrition Examination Survey Participants: US adults ≥18 years with type 2 diabetes Exposures: Race/ethnicity, income, and insurance status Main Measures: Low-cost noninsulin medications included any drugs that had at least one generic version approved by the Food and Drug Administration. Human regular, NPH, and premixed NPH/regular 70/30 insulins were classified as low-cost. All other noninsulin medications and insulins were considered high-cost Key Results: The sample included 7,394 patients. Prevalence of use of low-cost noninsulin drugs increased from 37% in 2003–2004 to 52% in 2017–2018. Use of high-cost noninsulin drugs decreased from 2003–2004 to 2013–2014 and then slowly increased. Use of low-cost insulin decreased from 7 to 2% while high-cost insulin rose from 4 to 16%. In multivariable analysis, non-White patients had 25–35% lower odds of receiving high-cost drugs than non-Hispanic Whites. Health insurance was associated with more than twice the odds of having high-cost drugs compared to no insurance. Patients with higher HbA1c or moderate obesity were also more likely to use high-cost drugs. Sex, income, and insurance type were not associated with receipt of high-cost drugs. Conclusions: There was a shift in utilization from high- to low-cost noninsulin drugs, but since 2013–2014 the trend has slowly reversed with increased use of newer, more expensive drug classes. High-cost insulin analogs have almost completely replaced lower cost human insulins. Disparities in receipt of diabetes drugs by race/ethnicity and insurance must be addressed to ensure that cost is not a barrier for disadvantaged populations.
- Subjects
UNITED States. Food &; Drug Administration; TYPE 2 diabetes; HEALTH &; Nutrition Examination Survey; INSULIN derivatives
- Publication
JGIM: Journal of General Internal Medicine, 2023, Vol 38, Issue 1, p49
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-022-07621-2