In a study appearing in the April 5 issue of JAMA, Philip Clarke, Ph.D., of the University of Melbourne, Australia, and colleagues analyzed individual and prescription-level data from the Medical Expenditure Panel Survey to describe and compare trends in expenditure and price of anti-hyperglycemic medications in the United States from 2002 through 2013.
The sample consisted of 27,878 people treated for diabetes. During the study period, the prevalence of treated diabetes increased from 5.2 percent in 2002-2004 to 7.7 percent in 2011-2013. For those with recorded insulin use, the quantity per year increased from 171 mL in 2002-2004 to 206 mL in 2011-2013; over the same period, estimated spending for insulin per patient increased from $231 in 2002 to $736 in 2013. In 2013, estimated expenditure per patient amounted to $508 for analog insulin and $228 for human insulin.
The total expenditure on insulin in 2013 was significantly greater than the combined expenditure on all other anti-hyperglycemic medications of $503. The average price per milliliter of insulin increased by 197 percent from $4.34 per milliliter in 2002 to $12.92 per milliliter in 2013, whereas the average price of dipeptidyl peptidase-4 (DPP-4) inhibitors increased by 34 percent from $6.67 per tablet in 2006 to $8.92 in 2013. The average price of metformin decreased by 93 percent from $1.24 per tablet in 2002 to $0.31 per tablet in 2013.
"Significant changes in mean price of insulin, relative to comparator therapies, suggest a need to reassess the effectiveness and cost-effectiveness of alternative anti-hyperglycemic therapies," the authors write.
(doi:10.1001/jama.2016.0126; this study is available pre-embargo at the For The Media website.)
Editor's Note: This research was partly supported by grants from the National Institutes of Health and the National Health and Medical Research Council. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.