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New Diabetes Drugs More Expensive, But Not Always Better

Oct 28, 2008 | Parker Waichman Alonso LLP

A new report has found that the cost for treating diabetes has skyrocketed, despite inconclusive evidence that newer, more expensive treatments provide added benefits to patients.

In 2002, diabetes accounted for more than 10 percent of U.S. health-care expenditures, and that number is expected to increase as the number of people with type 2 diabetes grows.   According to the study conducted by researchers at the University of Chicago and Stanford University, between 2001 and 2007, spending for drugs went from $6.7 billion to $12.5 billion.  

"We found dramatic changes in the treatment patterns for diabetes during the past decade," study author Dr. G. Caleb Alexander, an assistant professor of medicine at the University of Chicago, told The Washington Post. "This includes a remarkable change in drugs, as well as significant increases in costs."

The study attributes much the increased treatment costs to expensive new drugs, which can be 8 to 11 times more costly than older, generic diabetes drugs.  Such drugs, including Januvia, Byetta and Avandia, are marketed as being more convenient and offering better control of blood sugar than the older medicines.  In many cases the new drugs are being used instead of insulin, the use of which dropped from 38 percent in 1994 to 28 percent in 2007.

However, it is not clear just how much these new drugs are actually benefiting patients.  "There are some real innovations here," Alexander said. "But we don't know enough about the comparative effectiveness of these medicines compared with older medicines to make a final verdict."

In some cases, new diabetes drugs are found to have dangerous side effects after they are approved and have been prescribed to millions of people.  For instance, recently the diabetes drugs Avandia and Byetta have been the subject of safety concerns. On August 18, the FDA said that Byetta had been linked to 6 cases of hemorrhagic or necrotizing pancreatitis in patients taking Byetta since its October alert. All patients required hospitalization, two patients died and four patients were recovering at time of reporting. Byetta was discontinued in all 6 cases.  Then, on August 26, Amylin announced that four additional fatalities had been confirmed in Byetta patients suffering from milder forms of pancreatitis.

Concerns about Avandia arose in 2007, after a New England Journal of Medicine revealed data linking Avandia to an increased risk of heart attack.   Avandia, which has been on the market since 1999, has long carried warnings of its cardiovascular side effects, such as an increased risk for congestive heart failure and GlaxoSmithKline has known about concerns over Avandia’s heart attack risks since at least 2004; however, the heart attack risk was not mentioned in Avandia’s packaging information until November.  The FDA raised existing warnings about congestive heart failure after the New England Journal’s publication triggered a congressional inquiry.