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Out-of-Pocket Costs Way Up for Type 2 Diabetes

Study questions value of insulin analogs, but U.S. diabetes expert says they're cost-effective

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By 2010, those numbers had nearly reversed. About 91.5 percent of people taking insulin filled prescriptions for insulin analogs, while 14.8 percent received human synthetic insulin.

"If the transition has been driven by informed patients who benefit from this, great," Lipska said. "But I worry that a lot of this transition may have been driven by marketing, not informed patient preferences."

Out-of-pocket expenditures per prescription increased from a median of $19 to $36 over the 10-year review period, according to the findings published in the June 11 issue of the Journal of the American Medical Association.

"Taking into account the increased use of insulin among patients with type 2 diabetes, we can estimate -- with back-of-the-envelope calculations -- that out-of-pocket spending on insulin more than tripled from $133 million in 2000 to $432 million in 2010 for every 100,000 patients with type 2 diabetes," Lipska said.

Severe low blood sugar events declined slightly over the study period, but the difference wasn't statistically significant, the study authors said.

Ratner argued that the more expensive insulin analogs represent a financial tradeoff between the costs of controlling blood sugar levels versus caring for diabetes complications and emergencies.

Clinical trials have shown that insulin analogs help people with diabetes achieve the same control over their blood sugar levels but with a reduced risk of hypoglycemia, he said.

"We spent $21 billion on glucose-lowering therapies and monitoring in 2010," Ratner said. "That's a lot of money. But we spent $71 billion on hospital care. Right now, treating people with medication is less than one-third of the cost of treating their complications in the hospital."

He added that generic forms of many insulin analogs are in development and will soon reach the market.

"The availability of generic insulin analogs will drive down the cost difference," he said. "We will no longer have the cost difference, but we will have the clinical benefit."

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