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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


    Lipska and her colleagues examined trends in insulin use using data from an administrative claims database of privately insured people from throughout the United States, but with more representation from states in the South and Midwest. The analysis included adults 18 years or older with at least two years of continuous insurance coverage between January 2000 and September 2010.

    The researchers found that use of insulin among patients with type 2 diabetes increased from 10 percent in 2000 to 15 percent in 2010, a trend largely attributable to the widespread adoption of insulin analogs.

    Among adults using insulin, 96.4 percent filled prescriptions for regular human synthetic insulin in 2000, while 18.9 percent received insulin analogs.

    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.

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