Are the high costs of new diabetes drugs deterring eligible patients?

Based on nationally representative data, less than 10% of eligible US patients with type 2 diabetes used a GLP-1 receptor agonist or SGLT2 inhibitor.

An estimated 22.4 million US adults diagnosed with type 2 diabetes meet the American Diabetes Association and European Diabetes Association recommendations for the use of these agents, but GLP-1 receptor agonists was used by only 3.7% and 5.3%. SGLT2 inhibitors, and 9.1% of them were used from his 2017 to his 2020, reported Dr. Shichao Tang and his colleagues at the CDC’s Diabetes Translation Division in Atlanta.

Of note, 12.1% of patients who did not meet eligibility for these drugs were prescribed. This was more common with her GLP-1 receptor agonists (7.2%) than with SGLT2 inhibitors (4.9%). Annals of internal medicine.

“It’s important for primary care providers to be aware that many people with type 2 diabetes may be eligible for these drugs,” Tang said. MedPage Today.

He added that these results weren’t necessarily surprising, but they were insightful, especially when it came to the eligibility findings.

Why are so few eligible patients using these drugs? The researchers suggest that the “significantly” higher cost may be to blame.

A 2019 review of cost-effectiveness analyzes published in PharmacoeconomicsGLP-1 receptor agonists and SGLT2 inhibitors were considered cost-effective when prescribed as second-line drugs compared to insulin or sulfonylureas.

However, the 2022 cost-effectiveness study also Annals of Internal Medicine, We found that SGLT2 inhibitors and GLP-1 receptor agonists were not cost-effective when used as first-line drugs compared to the traditional first-line drug metformin. Lifespan compared to metformin, respectively.

To be considered cost-effective as a first-line drug, both drugs would have to be 70% cheaper, even if they had cardiovascular benefits.

“We note that the most recent data available for research are from a period when these two agents were not recommended as first-line therapy for many patients currently eligible under the 2022 guidelines. It’s important to be patient,” Tan said.

in the update 2022 Consensus Reportthe American Diabetes Association and the European Diabetes Association advised the use of GLP-1 receptor agonists in type 2 diabetics with established or high risk of atherosclerotic cardiovascular disease (ASCVD). SGLT2 inhibitors are recommended for patients with comorbid ASCVD, chronic kidney disease, heart failure, or those at high risk for ASCVD.

“Cost-effectiveness was not formally considered in current guidelines,” the researchers said. “Further research is needed to assess the cost-effectiveness of these drugs and determine exactly why these numbers are low,” Tang added.

“It is also important to continue research after the change in recommendations,” he said. “As new data become available, it may be useful to observe whether and how new recommendations affect the use of these treatments.”

For their estimates, the researchers included nonpregnant adults 20 years and older from the National Health and Nutrition Survey who self-reported diabetes. Excluded.

Based on the 2022 Consensus Report, 46% of patients met the recommended criteria for treatment with a GLP-1 receptor agonist and 82.3% met the criteria for treatment with an SGLT2 inhibitor.

When stratified by clinical factors, 100% of patients with ASCVD or at high risk for ASCVD, heart failure, or chronic kidney disease were eligible for one of these agents. Looking at duration of diabetes, approximately 73% of patients with diabetes duration of 5 years or less met eligibility criteria, 84.6% of patients with duration of 6 to 10 years, and 11 years or less of diabetes duration. jumped to 87.5%. more years. Roughly the same percentage of patients meeting or below the BMI threshold also met the criteria.

According to sociodemographic factors, a higher proportion of men than women met the recommendation criteria for SGLT2 inhibitors or GLP-1 receptor agonists (84.6% vs. 79.5%), and those aged 65 years and older were 65 years old It was so compared to those who were under. (97% vs. 70%) and those who were Caucasian vs. Non-Caucasian (83.6% vs. 80.5%).

When stratified by health insurance, almost all patients with Medicare were eligible for one of these drugs (94.5%), whereas patients with Medicaid (77.5%), OR uninsured (74.8%), and privately insured patients (65.4%) were also eligible. .