The costs of drug prescriptions for diabetes in the NHS

Stedman, Mike; Livingston, Mark; Fryer, Anthony A.; Moreno, Gabriela; Bailey, Susan M.; Gadsby, Roger; Heald, Adrian

doi:10.1016/s0140-6736(18)33190-8

Cited by 12 publications

(5 citation statements)

References 3 publications

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“…41 According to an analysis of data from a cluster-randomised trial, a diagnosis of GDM has been associated with 25% higher healthcare costs, with both the cost of inpatient visits and the use of neonatal intensive care unit being over 40% higher in women with GDM compared with those not diagnosed with GDM. 42 For the NHS, annual costs for blood glucose-lowering medication have exceeded £1 billion, 43 while it is expected that the overall cost of diabetes will account for 17% of the NHS total expenditure by 2035. 44 The early identification and prevention of T2DM in women affected by GDM during pregnancy should be regarded as an immediate priority.…”

Section: Screening Uptakementioning

confidence: 99%

Gestational diabetes: screening uptake, current challenges and the future – a focused review

et al. 2020

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The increased risk of developing type 2 diabetes mellitus (T2DM) in women with a history of previous gestational diabetes mellitus (GDM) has been established and is well recognised. Post-partum screening for T2DM is essential to identify those at higher risk and allow for the implementation of preventative interventions. However, attendance rates for post-partum glucose screening in women with previous GDM remain substantially low, with only half of them attending screening. This review aimed to outline the National Institute for Health and Care Excellence (NICE) post-partum screening recommendations and compare them with the guidelines being used worldwide, provide information on post-partum screening uptake and possible determinants of uptake in the UK, and to briefly discuss both patient health implications and the financial burden associated with T2DM progression in the context of the National Health Service (NHS).

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Section: Screening Uptakementioning

confidence: 99%

Gestational diabetes: screening uptake, current challenges and the future – a focused review

et al. 2020

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“…Existing guidelines and evidence recommend metformin as first-line treatment, sulfonylurea as second-line treatment (or first-line treatment if metformin is contraindicated) and insulin as third-line treatment [ 3 – 5 ]. Increasing evidence have suggested that anti-diabetic medications (ADMs) reduce the incidence of long-term complications, hospital admission, and mortality among patients with diabetes [ 6 ]. Evaluating the efficacy of short and long-term glycaemic changes of ADM have long been debated along with the increase demand of patient-centered diabetes treatment.…”

Section: Introductionmentioning

confidence: 99%

Changes in glycaemic control of oral anti-diabetic medications assessed by continuous glucose monitors among patients with type 2 diabetes: a protocol of network meta-analysis

et al. 2022

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Background Continuous glucose monitors (CGMs) can measure interstitial fluid glucose levels to provide comprehensive real-time glucose profile among people with type 2 diabetes. These can accurately detect glucose levels, hyperglycaemia and hypoglycaemia events compared with conventional self-monitoring. Increased application of CGMs provides a valuable opportunity to evaluate glucose control on oral anti-diabetic medications. This review will compare the efficacy and safety of oral anti-diabetic medications among patients with type 2 diabetes, evaluated by CGM. Methods The following databases will be searched: Cochrane Library, PubMed, EMBASE, CINAHL, PsycINFO, Scopus and grey literature (ClinicalTrials.gov, PsycEXTRA, ProQuest Dissertations, Google Scholar and Theses Global) for the identification of studies. The review will include and summarise evidence from randomised clinical trials that use CGMs for blood glucose management in adults (aged ≥ 18 years), published in English between January 2000 and May 2021 without any restrictions of countries. Reference list of all selected articles will independently be screened to identify additional studies left out in the initial search. Primary outcomes will be HbA1c (≤ 7.0%), time spent with hypoglycaemia (< 70 mg/dl) or hyperglycaemia (≥ 180 mg/dl). Secondary outcomes will be change in weight, blood pressure and related comorbidities (cardiovascular mortality, heart failure events, myocardial infarction and stroke). Study selection, data extraction and quality assessment will be conducted independently by at least two reviewers. A third reviewer will determine and resolve discrepancies. At least two independent reviewers will cross-check data synthesis. The quality of evidence of the review will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Tool. Discussion The review is anticipated to provide up to date evidence for further studies and clinic practices regarding glycaemic control, hypoglycaemia, and hyperglycaemia issues. The results will be published in a peer-reviewed journal. Trial registration PROSPERO CRD42020188399.

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“…In 2018, the annual prescription cost for glucose-lowering agents exceeded £1 billion in the UK with almost one in 20 GP prescriptions related to diabetes treatment. 4 This figure is predicted to continue to increase substantially in the next 20 years and, therefore, poses an enormous challenge for healthcare resources. Extracting maximal benefit without excessive cost should therefore be a key focus of T2DM prescribing.…”

Section: Introductionmentioning

confidence: 99%

“…The rising prevalence of diabetes and the advent of more expensive agents have substantially increased the cost of treating T2DM. In 2018, the annual prescription cost for glucose‐lowering agents exceeded £1 billion in the UK with almost one in 20 GP prescriptions related to diabetes treatment 4 . This figure is predicted to continue to increase substantially in the next 20 years and, therefore, poses an enormous challenge for healthcare resources.…”

Section: Introductionmentioning

confidence: 99%

Prescribing costs of hypoglycaemic agents and associations with metabolic control in Wales; a national analysis of primary care data

et al. 2022

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Aims: There has been a dramatic increase in hypoglycaemic agent expenditure.We assessed the variability in prescribing costs at the practice level and the relationship between expenditure and the proportion of patients achieving target glycaemic control. Methods:We utilized national prescribing data from 406 general practices in Wales. This was compared against glycaemic control (percentage of patients achieving a HbA1c level < 59 mmol/mol in the preceding 12 months). Analyses were adjusted for the number of patients with diabetes in each general practice and the Welsh Index of Multiple Deprivation.Results: There was considerable heterogeneity in hypoglycaemic agent spend per patient with diabetes, Median = £289 (IQR 247-343) range £31.1-£1713.Higher total expenditure was not associated with improved glycaemic control B (std) = −0.01 (95%CI -0.01, 0.002) p = 0.13. High-spend practices spent more on SGLT2 inhibitors (16 vs. 9% p < 0.001) and GLP-1 agonists (13 vs. 11% p < 0.001) and less on insulin (34 vs. 42% p < 0.001), biguanides (9 vs. 11% p = 0.001) and sulphonylureas (2 vs. 3% p < 0.001) than low spend practices. There were no differences in the pattern of drug prescribing between high spend practices with better glycaemic control (mean 68% of patients HbA1c <59 mmol/mol) and those with less good metabolic control (mean 58% of patients HbA1c <59 mmol/mol).Conclusions: Spend on hypoglycaemic agents is highly variable between practices and increased expenditure per patient is not associated with better glycaemic control. Whilst newer, more expensive agents have additional benefits, in individuals where these advantages are more marginal widespread use of these agents has important cost implications.

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The costs of drug prescriptions for diabetes in the NHS

Cited by 12 publications

References 3 publications

Gestational diabetes: screening uptake, current challenges and the future – a focused review

Gestational diabetes: screening uptake, current challenges and the future – a focused review

Changes in glycaemic control of oral anti-diabetic medications assessed by continuous glucose monitors among patients with type 2 diabetes: a protocol of network meta-analysis

Prescribing costs of hypoglycaemic agents and associations with metabolic control in Wales; a national analysis of primary care data

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