Fewer than 10% of American adults with type 2 diabetes who qualified for treatment with newer agents — such as an SGLT2 inhibitor or GLP-1 agonist — actually received treatment with at least one drug from drug class in 2017-2020, based on a new analysis of just over a thousand adults who participated in a representative, biannual survey and self-reported a diabetes diagnosis.
The cost of these agents, and their uncertain cost-effectiveness at current prices, is likely a key driver of the low usage rate, say the authors of a brief report published February 27 in Annals of Internal Medicine.
"Clinical studies have shown that both GLP-1 [glucagon-like peptide-1] receptor agonists and SGLT2 [sodium-glucose cotransporter 2] inhibitors yield additional clinical benefits compared with older treatments in reducing body weight and progression of cardiovascular disease and chronic kidney disease," write Shichao Tang, PhD, from the US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues.
"However, these medications come at a substantially higher cost," they stress.
Tang explained in an interview that the new study "points to prior studies about the high cost of these medications as a potential barrier to use, but more research is needed to understand cost-effectiveness and any potential barriers to use, including cost."
The work "did not include research into cost-effectiveness or why the percentage of people already using these medications was low," he emphasized.
Most Qualify, but Drug Cost-Effectiveness May Be Lacking at Current Prices
Tang and colleagues used data collected by the US National Health and Nutrition Examination Survey (NHANES) during two 2-year cycles between 2017 and 2020 that included 1417 people who self-identified a diagnosis of diabetes.
Excluding those who likely had type 1 diabetes and those with incomplete data left 1330 survey participants, including 1133 (85%) who fit criteria for the treatment of type 2 diabetes with an agent from one of the two studied classes, as recommended in 2022 by a panel representing the American Diabetes Association and the European Association for the Study of Diabetes.
Among these 1133 people — who represent more than 22 million American adults with type 2 diabetes who fit the 2022 criteria — a scant 3.7% were actually taking a GLP-1 agonist and 5.3% were taking an SGLT2 inhibitor.
"While it's important to note that our data predate the 2022 recommendations, these drugs were offered as second-line therapy for patients with certain diabetes-related complications in 2017-2020," and hence, provide potentially useful insights, noted Tang, a health economist with the CDC National Center for Chronic Disease Prevention and Health Promotion.
Based on retail prices listed on a US-based website, a 30-day supply of an oral SGLT2 inhibitor can cost about $550-$600/month, while common subcutaneously injected GLP-1 receptor agonists can run from a few hundred dollars for a daily injection or close to $1000 for a formulation administered weekly.
"Cost-effectiveness was not formally considered in the current guideline, but an assessment of cost-effectiveness may assist better targeting of interventions to achieve the greatest effect at a sustainable cost," the researchers conclude.
The study received no commercial funding. None of the authors had relevant financial relationships.
Ann Int Med. Published online February 27, 2023. Abstract
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