Economic Impact of Antidiabetic Medications and Glycemic Control on Managed Care Organizations: A Review of the Literature

Abstract

regarding the impact of antidiabetic medications and glycemic control on the overall costs of care for patients with diabetes in U.S. managed care organizations (MCOs).SUMMARY: The pharmacy component accounts for typically 20% to 30% (full range, 10%-65%) of overall costs for MCO patients with diabetes. About 30% of pharmacy expenses are directly related to glycemic control, while the balance is spent on the management of macrovascular and microvascular complications related to diabetes and other common comorbidities such as hypertension and hyperlipidemia. Cost offsets and/or cost savings have been shown with the initiation of insulin therapy, including the use of newer short-acting insulins. Increasing medication possession ratios for antidiabetic medications (including insulins) are correlated with reduced overall health care costs, particularly reductions in hospitalization rates. Patients with diagnosed diabetes not receiving medications have significantly increased health care resource utilization. We identified 8 studies that indicatred that improvements in glycemic control lower overall per-patient direct costs within MCOs.CONCLUSIONS: The literature to date suggests that improving glycemic control and antidiabetic medication persistence reduce overall medical costs for patients with diabetes in managed care plans. Continued expansion of antidiabetic medication options will place increasing pressure on MCOs to assess the return on investment for newer pharmacotherapies. Routine measurement of economic and quality-of-life outcomes alongside clinical outcomes will become necessary for assessing the total value that new antidiabetic medications provide and whether cost offsets to managed care exist. Appropriate use of antidiabetic medications, including medication compliance, is an important component in a strategy to achieve glycemic control and may improve outcomes for patients with diabetes.

Medical Claim Cost Impact of Improved Diabetes Control for Medicare and Commercially Insured Patients with Type 2 Diabetes

“…14 In a systematic review of the literature (January 2000-November 2005) assessing the effect of antidiabetic medications and glycemic control on cost in patients with diabetes who were members of U.S. managed care organizations, investigators identified 8 studies showing that improved glycemic control reduces overall perpatient direct costs; of interest, the pharmacy component usually represented 20% to 30% of overall costs, and about 30% of pharmacy charges were directly correlated with glycemic control. 15 The current analysis was based on a hypothetical cohort of commercially insured and Medicare fee-for-service patients with type 2 diabetes who were identified from the NHANES database. Applying the United Kingdom Prospective Diabetes Study (UKPDS) complication risk model to the individual's risk characteristics, the analysis simulated diabetes complication rates under status quo risk factor profiles and complication reductions associated with improved management of A1c, BP, and lipids.…”

The Impact of Diabetes and Associated Cardiometabolic Risk Factors on Members: Strategies for Optimizing Outcomes

“…11 Total health plan costs generated by members with diabetes are largely determined by the size and nature of the patient mix. Patient attributes that can affect health plan spending related to diabetes are listed in Table 4.…”

“…[9][10] The annual cost of CVD reportedly ranges from $8,200 to $13,100 per person, depending on the presence of diabetes. 11 In general, spending on individuals with diabetes is substantially higher than spending on those without diabetes. The American Diabetes Association (ADA) estimated that, in 2002, annual per capita medical expenditures were 2.4 times higher for people with diabetes than for similar people without diabetes.…”

“…13 The growing use of 3 drug classes (i.e., lipid-lowering, antihyperglycemic, and antihypertensive agents) is the result of a larger treatment population and more aggressive treatment goals. 11,13 According to the Medco Drug Trend Reports, in the past 3 years, the increase in the rate of use of these 3 drug classes has been greater than the average increase of 2.7% for all prescription drugs. [13][14][15][16] In 2006, the rates of use of lipid-lowering and antihyperglycemic agents increased by 6.2% and 5.1%, respectively.…”

Measuring Value in the Treatment of Symptoms of Allergic Rhinitis With Nasal Steroids

“…34 The place in therapy for TZDs in type 2 diabetes is summarized clearly and succinctly in the NICE (National Institute for Clinical Excellence) appraisal released in November 2002. TZDs are third-line therapy in type 2 diabetes after sulfonylureas and metformin have proved unsuccessful when used as monotherapy and in combination to achieve glycemic goals.…”