A drug utilization and pharmacoeconomic study of anti-diabetic drugs prescribed to type 2 diabetes mellitus patients visiting the medicine out-patient department of a tertiary care hospital of north India

Abstract

INTRODUCTIONType 2 diabetes mellitus (T2DM) is the commonest form of diabetes (responsible for >90% cases of diabetes) affecting around 422 million people in the world, and more than 80% of diabetes deaths occur in low-and middle-income countries.1 The treatment of patients with T2DM involves diet, exercise and lifestyle modifications. Those not controlled are put on oral anti-diabetic (OAD) agents, the most commonly used being sulfonylurea's and ABSTRACT Background: Type 2 diabetes mellitus (T2DM) patients require anti-diabetic drugs on chronic basis, frequent monitoring of blood glucose levels and a number of laboratory investigations, all of which result in significant economic burden on the diabetes patients and the world economies. The purpose of this study was to analyse the prescribing pattern to highlight the current approaches to the rational use of anti-diabetic drugs in T2DM patients visiting the medicine out-patient department, and to calculate the economic burden of different antidiabetic therapies prescribed to patients with T2DM in a tertiary care hospital of north India. Methods: This prospective study included T2DM patients visiting the outpatient department of medicine of a tertiary care hospital of Uttarakhand, India. Prescriptions of patients diagnosed as cases of T2DM were analysed as per the WHO drug use indicators. For pharmacoeconomic evaluation, the cost variation of different anti-diabetic therapies was compared using the cost-effectiveness analysis method. Results: 273 prescriptions from 148 men and 125 women were analysed. 805 drugs were prescribed to the patients with an average of 2.95 per encounter: 494 anti-diabetic drugs with an average of 1.81 drugs per patient, and 311 for comorbid conditions. Of the 494 anti-diabetic drugs, 75.1% were oral anti-diabetic (OAD) agents and 24.9% were insulin's. Metformin (209) and insulin aspart (42) were the most prescribed OAD and insulin, respectively. The pharmacoeconomic analysis included 138 patients. The cost per unit (1 mg/dl) reduction in fasting blood glucose was lowest with glipizide and metformin combination (INR 10.46) and highest with insulin degludec and insulin aspart combination (INR 217.38). The average total direct cost of therapy for two months was INR 2244.39 ± 2745. 86.63% of the average total direct cost of therapy was attributed to anti-diabetic agents. Conclusions: Metformin was the most common OAD agent and insulin aspart was the most common injectable anti-diabetic drug prescribed in patients with T2DM. The newer anti-diabetic drugs sitagliptin and newer insulin analogues were also prescribed to a great extent. Overall, the prescribing trend was rational to a great extent and had improved since the earlier study in the same institute. The most cost-effective anti-diabetic therapy was combination therapy of glipizide and metformin. The cost of diabetes management is high, especially for insulin therapy.

Prescribing pattern and pharmacoeconomic analysis of antidiabetic drugs

“…It could be due to this study being a cross sectional study captured data 2 days/ week. [12][13][14] In this study, average number of drugs was 6.6 per prescription. The WHO proposes that optimally, this should be <2.…”

“…Drug utilization studies conducted by Kakade A et al, and Singh A et al, showed than more than half of prescribed drugs were fixed dose combinations (60% and 71.06% respectively). 14,18 Possible reason for prescribing fixed dose combinations could be that it is convenient to take one or two pills a day rather than taking several drugs with individual formulations. But in this study it is about 50% of reported in literature, it could be due to tertiary care centre where commonly drugs available as combination have already outlived their trial.…”

Prescribing pattern of anti-diabetic drugs and adherence to the American Diabetes Association’s (ADA) 2021 treatment guidelines among patients of type 2 diabetes mellitus: A cross-sectional study

“…A similar prescribing pattern of FDC was found in other studies which reported 60% and 71.06% of FDC prescription. [ 10 11 ] The reason behind the change in prescribing patterns is that pharmacotherapy for diabetes mellitus has dramatically changed in the last few years. The prescription trend is shifting toward FDCs that simplify the treatment regimen by reducing pill burden compared with the same combination delivered as separate pills.…”

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“…Given the prevalence and complications of diabetes an analysis to determine the economic impact of the treatment option being prescribed in tertiary care hospital of northern India. A pharmacoeconomic study thus becomes necessary to throw light on the current approaches to the rational use of anti-diabetic drugs in type II diabetes mellitus patients visiting the medicine out-patient department, and to calculate the economic burden of different anti-diabetic therapies prescribed to patients with type II diabetes mellitus 7 . Knowledge of costs related to diabetes helps to improve understanding, addressing health care and prevention issues associated with diabetes.…”

“…Singh et al7 , the cost per unit (1 mg/dl) reduction in FBG (ACER) was highest with FDC of insulin degludec and insulin aspart (INR 217.38) and lowest with FDC of glipizide and metformin (INR 10.46). Among the OADs, the ACER was highest with voglibose (INR 62.79).…”