US spending on diabetes drugs nearly doubled to $12.5 billion over the last 6 years, according to a study published in this week’s Archives of Internal Medicine.
The cost escalations were driven by a 40% increase in the number of drugs prescribed per patient and a tendency to prescribe newer, costly drugs in lieu of tried-and-true generics despite safety concerns swirling around some of the newer ones.
The study investigators noted that the newer drugs Januvia (Merck, FDA approved in 2006), Avandia (GlaxoSmithKline, FDA approved 2006), and the wildly popular Actos (Takeda, FDA approved 1999) were prescribed in 28% of all doctor visits by the end of the study period.
“We need to pay attention to this,” Dr. David Nathan wrote in an accompanying editorial. Nathan, who is Chief of the Diabetes Unit at Massachusetts General Hospital, added “if you can achieve the same glucose control at lower cost and lower side effects, that’s what you want to do.”
Current guidelines for Type 2 (adult onset) Diabetes recommend metformin, a generic drug that costs about $30 per month along with dietary modifications and exercise as first-line therapy. The guidelines suggest adding other drugs for patients who fail to respond adequately, but the recommendations specifically do not include Avandia which costs nearly $225 per month.
Last year, the FDA released a safety alert for Avandia after a meta-analysis revealed an increased risk of heart attacks in patients taking the drug. There are no safety concerns of this sort for Actos or Januvia.
About 24 million Americans have Type 2 diabetes.