Diminishing Cost-Effectiveness Hurting Case for New Glucose-Lowering Agents


While advances in glucose-lowering therapies have been practice-changing, a new analysis suggests patients could achieve greater cost-effectiveness with older agents.

A new literature review presented at the American Diabetes Association’s 81st Scientific Sessions (ADA 2021) detail how the rising cost of glucose-lowering medications have been crushing the agents’ ability to be cost-effective.

Using data from a dozen cost-effectiveness studies of glucose-lowering agents published from 2000-2018, results of the study indicate the prices of DPP-4 inhibitors and SGLT2 inhibitors have nearly doubled since their market entrance and also suggest about 50% of the studies published in 2018 found use of newer medication was not a cost-effective option for patients.

With the rising cost of diabetes management becoming an issue for many, Hui Shao, MD, PhD, Assistant Professor at the University of Florida College of Pharmacy, and a team of colleagues sought to explore how the cost of newer glucose-lowering has influenced their cost-effectiveness compared to older therapies. To do so, investigators designed their study as a systematic literature review to identify US-based cost effectiveness studies comparing DPP-4 inhibitors, GLP-1RAs, and SGLT2 inhibitors with older glucose-lowering drugs.

Searching for studies conducted between 2000-2018, a total of 12 studies were identified for inclusion. For inclusion in the literature review, studies needed to collect data related to treatment duration, costs, effectiveness, discount rates, and the incremental cost-effectiveness ratio (ICER) of newer and older drugs. For the purpose of analysis, measurements of the total payment for medication claims were extracted from the 2018 IBM MarketScan Commercial Claims database.

Upon analysis, investigators found only 1 of the 12 studies suggested older drugs were cost-effective based on drug costs prior to 2010. However, after updates based on the 2018 pricing of these agents, results suggested 58% (n=7) of studies were in favor of the older glucose-lowering drugs.

All 4 studies comparing newer agents to thiazolidinediones favored newer glucose-lowering drugs in the initial analysis, but all 4 studies favored thiazolidinediones after the cost update. In 4 studies comparing newer agents against sulfonylureas, 2 suggested sulfonylureas were more cost-effective after the 2018 cost update. Additionally, all 4 studies suggested newer drugs were cost-effective compared to insulin in the original study and just 1 drew a different conclusion when using the updated drug costs. Investigators highlighted a sensitivity analysis indicated these results were robust up to a 30% cost rebate.

Investigators pointed out the drug prices of metformin, sulfonylurea, and thiazolidinedione in 2018 had decreased to 46%, 22%, and 8%, respectively, of their market prices in 2005. In contrast, the cost of DPP-4 inhibitors, GLP-1RAs, and SGLT2 inhibitors increased to 1.9, 1.8, and 1.4 times the cost of the price of market entrance, respectively.

To learn more about the changing cost-effectiveness of newer glucose-lowering agents, Endocrinology Network and that conversation is the subject of this ADA 2021 House Call.

This study, “The Diminishing Cost-Effectiveness of the Newer Glucose-Lowering Drugs in the United States, 2010-2018,” was presented at ADA 2021.

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