National health insurance expenditure related to diabetes represents €10 billion, i.e. 8% of all expenditure. Mean expenditure per diabetic patient has stabilized since 2012, but the use of expensive new drugs could modify this curve.

METHODS:

This study was based on the population covered by the national health insurance general scheme that had received ≥1 reimbursement for antidiabetic drugs in 2012 and ≥1 reimbursement 3 years later. Treatment regimens were defined in the French health insurance system database (SNIIRAM) by reimbursements over a 4-month period to minimize the risk of wrongly attributing a modification of monotherapy to dual therapy. Projections were performed until 2020.

RESULTS:

Between 2012 and 2015, monotherapy and triple therapy rates remained stable (39% and 13% of patients), while the use of dual therapy decreased from 25% to 23% and the use of insulin therapy increased from 23% to 25%. Use of an insulin + other antidiabetic combination increased from 53% to 56%.

The use of metformin, gliptins and GLP-1 agonists increased, while the use of sulphonylureas and other antidiabetics decreased.

Expenditure related to antidiabetics increased from €1.09 billion to €1.2 billion. Half of the increased expenditure related to insulin therapy (€514 to €614 million) was due to the increased use of insulin + GLP-1 agonist combinations (€62 to €115 million, +€53M).

Simple projection of the number of diabetic patients would result in an increase in the expenditure attributable to antidiabetics of +€178M between 2015 and 2020. According to various assumptions (treatment intensification, increasing use of certain molecules), this increase would be situated between +€208M and +€562M.

CONCLUSIONS:

The financial impact related to modifications of the treatment modalities of diabetes constitutes a major challenge to a health system subject to budgetary constraints and in the presence of innovative treatments in fields such as oncology or hepatitis C.