A progressively more complex and expensive array of therapys for type 2 diabetes is being prescribed to an increasing number of adults, as per a report in the October 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

In 2000, more than 11 million Americans had been diagnosed with diabetes, as per background information in the article. "By 2050, the number of Americans with diabetes is expected to soar to 29 million, a prevalence of 7 percent," the authors write. "The annual economic burden of diabetes is estimated at $132 billion and increasing. In 2002, more than one-tenth of U.S. health care expenditures were attributable to diabetes." As costs and prevalence increase, managing diabetes also has become increasingly complex, as physicians prescribe more medications to each patient and combine drugs from different therapeutic classes.

To evaluate these trends, G. Caleb Alexander, M.D., M.S., of the University of Chicago Hospitals, and his colleagues gathered diabetes prescription information and costs from national databases. The scientists analyzed prescription data from U.S. patients age 35 and older with type 2 diabetes who visited a physician's office between 1994 and 2007. Information about medicine costs was available from 2001 to 2007.

The analysis revealed that, between 1994 and 2007:

• The estimated number of yearly patient visits to treat diabetes increased from 25 million to 36 million

• The average number of medications prescribed per treated patient increased from 1.14 to 1.63

• Among visits in which any therapy was given, the number in which only one drug was prescribed decreased from 82 percent to 47 percent

• Insulin use decreased from 38 percent in 1994 to a low of 25 percent in 2000, and then increased again to 28 percent

• The types of medications prescribed shiftedthe use of sulfonylurea drugs decreased from 67 percent to 34 percent of therapy visits, while use of newer drugs such as biguanides and glitazones increased, so that by 2007 these agents were prescribed at 54 percent and 28 percent of therapy visits, respectively

The increasing use of glitazonesalong with other new therapys, including new forms of insulin and other new classes of drugsaccounted for increases in average cost per prescription (from $56 in 2001 to $76 in 2007) and in overall medicine expenditures for those with diabetes (from $6.7 billion in 2001 to $12.5 billion in 2007).

"We document large shifts in patterns of diabetes therapy and pharmaceutical expenditures across therapy classes," the authors conclude. "Whether increased therapy costs are balanced by improved outcomes linked to these changes cannot be reviewed in the absence of data comparing effectiveness and cost-effectiveness across therapy classes. Our findings suggest the importance of generating new comparative data and coupling this information with clinical and formulary guidelines that contribute to constraining costs, maximizing glycemic control and minimizing diabetes-related morbidity and mortality".


Posted by: Josly2006    Source

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