Trends in Outpatient Prescription Drug Costs in Diabetic Patients in Germany, 1994–2004

Abstract

OBJECTIVE -New antidiabetic medications have been introduced during the last decade, but their impact on health care cost is largely unknown. Prescription costs in diabetic patients in primary care in Germany were evaluated (1994 -2004).RESEARCH DESIGN AND METHODS -A total of 46,017 diabetic patients and 46,017 age-and sex-matched control subjects in 400 nationwide practices (2004) were compared with 29,956 diabetic patients and 13,226 control subjects (361 practices) in 1994 (data from IMS HEALTH). Inflation-adjusted age-and sex-standardized costs (ex-manufacturer prices) were calculated.RESULTS -Mean annual total prescription costs per diabetic patient were €559 in 2004 (€372 in 1994), equaling a 60% (standardized) increase (P Ͻ 0.01). Average costs for antidiabetic medication were €172 in 2004, a 100% increase (P Ͻ 0.01). The major antidiabetic cost factor was insulin and analogs, which accounted for 22% of total drug costs in diabetic patients in 2004 (17% in 1994). All oral antidiabetic drugs together accounted for 8% of total costs (6% in 1994). New drugs (glitazones, glinides, and insulins) accounted for 15% of total costs (40% of antidiabetic drugs) in 2004. A 40% increase (€387 vs. 286) in all non-diabetes-related drugs was due mainly to cardiovascular and lipid-lowering drugs. In nondiabetic patients, only a 30% cost increase was found (€210 vs. 147; P Ͻ 0.01).CONCLUSIONS -Prescription drug costs among diabetic patients increased 60% during the last decade, which was twofold higher than the increase in nondiabetic patients. New types of antidiabetic drugs accounted for a substantial cost share of the overproportional increase for diabetes treatment. Progress in pharmacological therapy is a key driver of drug expenditure growth in diabetes treatment. Diabetes Care 30:848 -853, 2007D uring the last decade, antidiabetic prescription patterns have become increasingly complex (1-3). This complexity is the result of both the expanding evidence obtained from major clinical trials on intensified treatment of type 2 diabetic patients (e.g., the U.K. Prospective Diabetes Study) and the launch of new medications such as human insulin analogs (4). In particular, continuously increasing prescription use of insulin was observed during the last decade in European countries (5,6). Since 1995, the number of insulin prescriptions has almost doubled in Germany (5). Currently, 27% of diabetic patients receive insulin prescriptions, based on German health insurance data (7). Among oral antidiabetic drugs, prescription use of biguanides increased fourfold during the last decade, whereas use of sulfonylureas has steadily declined (5).In most countries including Germany, the majority of diabetic patients are treated predominantly by general practitioners and internists. There has been no evaluation of current trends in prescription use and costs among diabetic patients in the German primary health care system. To our knowledge, there also has been no longitudinal cost analysis from other European countries. In 1994, we foun...

Mortality risk with sulphonylureas compared to metformin

“…However, metformin has only been licensed by the US FDA since 1995 [6]. A decrease in the prescribing of sulphonylureas and an increase in the prescribing of metformin have also been observed in Germany, Italy and Japan [7][8][9][10].…”

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“…Several studies have targeted the prescription of antihyperglycemic drugs and the cost of these medications in Germany. [9][10] In 2007, Rathmann and colleagues discovered that there had been a 100% increase in the average cost for antidiabetic medication between 1994 (€86.7) and 2004 (€172.1). 9 More recently, Tamayo et al further found regional and individual social disparities in the cost of overall and newer antihyperglycemic medications unexplained by other confounders.…”

Outpatient Diabetic Care in a Public Central Hospital: Patient Characteristics, Therapeutic Regimens and Results

“…It is therefore not surprising that health care costs more than double after the diagnosis of diabetes is made, although it may be more unexpected that per capita costs are greater in type 2 diabetics and that hospitalizations account for more than 70% of these costs [5]. In the last 10 years, prescription costs for diabetics increased by more than 50% [6].…”