Trends in Antidiabetic Medication Use and Outpatient Pharmacy Costs in a Commercially Insured Diabetes Population from a US Payer Perspective
Author(s)
Bertha De Los Santos, MS, PharmD, Kibum Kim, PhD;
University of Illinois Chicago Retzky College of Pharmacy, Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA
University of Illinois Chicago Retzky College of Pharmacy, Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA
Presentation Documents
OBJECTIVES: Newer antidiabetic agents (ADAs) have influenced the management of type 2 diabetes (T2D). However, trends in the share of T2D care costs attributable to ADAs remain unclear. This study analyzed ADA utilization patterns and outpatient pharmacy costs in a T2D population from a US payer’s perspective.
METHODS: We conducted an annual prevalence-based economic assessment using the MarketScan commercial claims and encounters databases (2016-2021). Individuals with T2D were identified by ≥2 T2D diagnosis codes within a calendar year. ADA utilization was assessed using outpatient pharmacy claims, and the annual proportion of patients using each class was calculated. All-cause outpatient pharmacy costs were reported as median (IQR) per patient per year (PPPY) by ADA class, adjusted to January 2024 US dollars. We also evaluated the annual proportion of all-cause pharmacy costs attributable to each ADA class.
RESULTS: From 2016 to 2021, glucagon-like peptide-1 receptor agonist (GLP1RA) use increased from 13.1% to 33.3%, and sodium-glucose co-transporter 2 inhibitor (SGLT2I) use increased from 16.7% to 28.1%. Dipeptidyl peptidase-4 inhibitor (DPP4I) use decreased from 21.5% to 14.9%, sulfonylureas (SU) from 30.4% to 24.8%, and insulin from 30.6% to 26.8%. Thiazolidinedione (TZD) use remained low at 6.8% throughout. In 2021, the median (IQR) outpatient pharmacy costs among patients with T2D was $5,585 ($1,071-11,815). Overall expenditure on the pharmacy service among the T2D population was driven by insulin and GLP1RA users, with respective median (IQR) all-cause outpatient pharmacy costs of $11,277 ($5,658-$19,084) and $11,923 ($7,516-$17,910). Spending on GLP1RAs increased from 7.7% to 24.5% of total all-cause outpatient pharmacy costs, while SGLT2I spending increased from 6.4% to 13.1% over the study period.
CONCLUSIONS: The increasing use of novel ADA classes and their growing share of outpatient pharmacy costs accounted for a recent increase in overall diabetes care costs, highlighting the need for cost containment in T2D management.
METHODS: We conducted an annual prevalence-based economic assessment using the MarketScan commercial claims and encounters databases (2016-2021). Individuals with T2D were identified by ≥2 T2D diagnosis codes within a calendar year. ADA utilization was assessed using outpatient pharmacy claims, and the annual proportion of patients using each class was calculated. All-cause outpatient pharmacy costs were reported as median (IQR) per patient per year (PPPY) by ADA class, adjusted to January 2024 US dollars. We also evaluated the annual proportion of all-cause pharmacy costs attributable to each ADA class.
RESULTS: From 2016 to 2021, glucagon-like peptide-1 receptor agonist (GLP1RA) use increased from 13.1% to 33.3%, and sodium-glucose co-transporter 2 inhibitor (SGLT2I) use increased from 16.7% to 28.1%. Dipeptidyl peptidase-4 inhibitor (DPP4I) use decreased from 21.5% to 14.9%, sulfonylureas (SU) from 30.4% to 24.8%, and insulin from 30.6% to 26.8%. Thiazolidinedione (TZD) use remained low at 6.8% throughout. In 2021, the median (IQR) outpatient pharmacy costs among patients with T2D was $5,585 ($1,071-11,815). Overall expenditure on the pharmacy service among the T2D population was driven by insulin and GLP1RA users, with respective median (IQR) all-cause outpatient pharmacy costs of $11,277 ($5,658-$19,084) and $11,923 ($7,516-$17,910). Spending on GLP1RAs increased from 7.7% to 24.5% of total all-cause outpatient pharmacy costs, while SGLT2I spending increased from 6.4% to 13.1% over the study period.
CONCLUSIONS: The increasing use of novel ADA classes and their growing share of outpatient pharmacy costs accounted for a recent increase in overall diabetes care costs, highlighting the need for cost containment in T2D management.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE118
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)