An Update on the Utilization and Expenditure Associated With Medicines for the Treatment of Diabetes, Over a 10-Year Period in Ireland

OBJECTIVES: Diabetes is increasing in incidence and prevalence globally, and represents a major challenge for health systems. The aim of the study is to describe the utilization and expenditure associated with medicines for the treatment of diabetes in Ireland, over a 10-year period.

METHODS: This repeated, cross-sectional study was performed using the Health Service Executive Primary Care Reimbursement Services (HSE-PCRS) national pharmacy claims databases which include the General Medical Services (GMS), the Long-Term Illness (LTI) scheme, and the Drugs Payment (DP) scheme. Data was included on claims from 01 January 2014 to 31 December 2023 for dispensed medicines that are licensed for the treatment of diabetes (ATC-Code A10).

RESULTS: There has been an increase in the number of patients in receipt of insulin over the 10-year period; from 48,000 patients in 2014 to 54,000 patients in 2023. In 2014, there were over 134,000 patients receiving metformin (or metformin combination products), increasing to 186,000 patients in 2023. However, there has been a large increase in the utilization of GLP-1 analogues, with 9,900 patients treated in 2014, increasing to 58,000 patients in 2023. The total expenditure associated with GLP-1 analogues was over €61 million in 2023. The largest increase in utilization is observed for SGLT-2 inhibitors; from approximately 2,400 patients in 2014 to 83,000 in 2023. The total expenditure associated with SGLT-2 inhibitors was over €32 million in 2023.

CONCLUSIONS: This study provides evidence that newer agents such as GLP-1 analogues and SGLT-2 inhibitors are changing the landscape of diabetes treatment in Ireland. The increase in diabetes incidence over time, along with the utilization of higher-cost agents, poses an economic challenge to the healthcare payer. The use of health technology assessment in combination with health technology management should be used as a means to ensure effective and cost-effective utilization of medicines.