THE COST OF DIABETES CARE: HEALTHCARE SPENDING AND TREATMENT UTILIZATION AMONG DAMAN BENEFICIARIES IN SAUDI ARABIA
Author(s)
Ibrahim Abdulrahman Aljuffali, PhD1, Shabab AlGhamdi, MD1, Ahmed Aljedai, MBA, PharmD2, Mohammed Aljumah, Professor of Neurology3, Joelle Barhoun, Masters Artificial Intelligence, System, and Data4, Myriam Bechwati, Pharm D4, Nada Ahmed Alagil, BA, RPh1.
1Council of Health Insurance (CHI), Riyadh, Saudi Arabia, 2Alfaisal University, RIYADH, Saudi Arabia, 3Itkan Consulting Group, Riyadh, Saudi Arabia, 4CCHO, Dubai, United Arab Emirates.
1Council of Health Insurance (CHI), Riyadh, Saudi Arabia, 2Alfaisal University, RIYADH, Saudi Arabia, 3Itkan Consulting Group, Riyadh, Saudi Arabia, 4CCHO, Dubai, United Arab Emirates.
OBJECTIVES: Real-world evidence on type 2 diabetes mellitus (T2DM) among insured individuals in Saudi Arabia (Daman beneficiaries) remains limited. This study aims to characterize T2DM prevalence, healthcare spending, and antidiabetic medication utilization patterns among Daman beneficiaries in Saudi Arabia.
METHODS: A retrospective cross-sectional claims analysis was conducted using the National Platform for Health Information Exchange Services (NPHIES) database, covering January 2024-December 2024. Claims-based diagnosed prevalence was estimated using an extended identification period (January 2023-December 2024) to improve case capture. Daman beneficiaries with continuous enrollment and ≥ 1 medical claim containing an ICD-10-AM diagnosis code for T2DM (E11) were included. Patients with other diabetes types or missing key identifiers/dates were excluded. Descriptive analyses evaluated demographic characteristics, healthcare spending, and antidiabetic medication utilization patterns.
RESULTS: A total of 740,041 existing patients met the inclusion criteria, corresponding to a claim-based diagnosed prevalence of 5.87% among Daman beneficiaries. Patients were predominantly male (75%), with highest prevalence among those aged ≥61 years. T2DM accounted for 4.13% of total healthcare spending, with pharmaceuticals representing 48.02% of T2DM-related spending. Insulins accounted for the largest share of diabetes medication spending (30%) followed by oral combination therapies, while Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) ranked third, reflecting rapid uptake among Daman beneficiaries. Semaglutide, a GLP-1 RA, accounted for the highest spending among individual agents. Although generics represented 53% of claims volume, branded therapies accounted for 65% of pharmaceutical spending.
CONCLUSIONS: Pharmaceutical costs represented a major component of T2DM-related healthcare spending among Daman beneficiaries in Saudi Arabia. The growing spending contribution of GLP-1 receptor agonists and branded therapies suggests potential opportunities for evidence-based formulary optimization and efficient resource allocation within private healthcare systems.
METHODS: A retrospective cross-sectional claims analysis was conducted using the National Platform for Health Information Exchange Services (NPHIES) database, covering January 2024-December 2024. Claims-based diagnosed prevalence was estimated using an extended identification period (January 2023-December 2024) to improve case capture. Daman beneficiaries with continuous enrollment and ≥ 1 medical claim containing an ICD-10-AM diagnosis code for T2DM (E11) were included. Patients with other diabetes types or missing key identifiers/dates were excluded. Descriptive analyses evaluated demographic characteristics, healthcare spending, and antidiabetic medication utilization patterns.
RESULTS: A total of 740,041 existing patients met the inclusion criteria, corresponding to a claim-based diagnosed prevalence of 5.87% among Daman beneficiaries. Patients were predominantly male (75%), with highest prevalence among those aged ≥61 years. T2DM accounted for 4.13% of total healthcare spending, with pharmaceuticals representing 48.02% of T2DM-related spending. Insulins accounted for the largest share of diabetes medication spending (30%) followed by oral combination therapies, while Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) ranked third, reflecting rapid uptake among Daman beneficiaries. Semaglutide, a GLP-1 RA, accounted for the highest spending among individual agents. Although generics represented 53% of claims volume, branded therapies accounted for 65% of pharmaceutical spending.
CONCLUSIONS: Pharmaceutical costs represented a major component of T2DM-related healthcare spending among Daman beneficiaries in Saudi Arabia. The growing spending contribution of GLP-1 receptor agonists and branded therapies suggests potential opportunities for evidence-based formulary optimization and efficient resource allocation within private healthcare systems.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR57
Topic
Health Policy & Regulatory, Real World Data & Information Systems
Topic Subcategory
Insurance Systems & National Health Care
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)