OBJECTIVES: Diabetes is a prevalent non-communicable disease worldwide associated with high morbidity, mortality and a lower quality of life. KSA ranks 7^th in the rate of diabetes worldwide with an estimated disease prevalence of around 24%. The Kingdom is witnessing a worsening pattern of diabetes with 10-fold increase over the past 30 years resulting in significant financial burden on payers. The aim of the study is to determine the cost of in-patient and out-patient diabetes pharmacotherapy in KSA.

METHODS: A retrospective analysis was done for the years 2018, 2019 and 2020 on all diabetic patients in the dataset of a third-party administrator. The outcomes of the study include the annual treatment cost per patient, in addition to the most prescribed medications with their respective cost.

RESULTS: A total of 118,631 patients were included in the cohort (85% male, 15% females) with a median age of 50 [42-57]. The median annual cost per patient was 62.94 USD [23.42-185.54] in 2018, 86.18 USD [29.7-249.43] in 2019, and 118.1 USD [44.44-303.31] in 2020, showing an increase of 88%. At the cohort level, the most prescribed medications were glimepiride and metformin with a corresponding annual cost of 422,872.78 USD and 134,116.93 USD, respectively. The annual cost of metformin/vildagliptin (552,680.01 USD) combination was the highest accounting for 0.05% of the patients, followed by glimepiride, metformin/sitagliptin (351,324.77 USD) and Glargine (330,078.47 USD) accounting for 0.03% and 0.01% of the patients, respectively.

CONCLUSIONS: The annual treatment cost per patient increased between 2018 and 2020. Private payers are incurring disproportionally higher costs for fewer number of patients, suggesting options for rationalization for better treatment coverage.