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. 2022 Sep;39(9):e14908.
doi: 10.1111/dme.14908. Epub 2022 Jul 19.

Prescribing costs of hypoglycaemic agents and associations with metabolic control in Wales; a national analysis of primary care data

Peter N Taylor  1 , Qi Zhuang Siah  1 , Omar Marei  1 , Mia McDade-Kumar  1 , Nasser Rachedi  1 , Robert Bracchi  2 , Richard Boldero  2 , Kath Haines  2 , Mohammed Alhadj Ali  1 , Robert French  1 , Colin M Dayan  1
Affiliations

Prescribing costs of hypoglycaemic agents and associations with metabolic control in Wales; a national analysis of primary care data

Peter N Taylor et al. Diabet Med. 2022 Sep.

Abstract

Aims: There has been a dramatic increase in hypoglycaemic agent expenditure. We assessed the variability in prescribing costs at the practice level and the relationship between expenditure and the proportion of patients achieving target glycaemic control.

Methods: We utilized national prescribing data from 406 general practices in Wales. This was compared against glycaemic control (percentage of patients achieving a HbA1c level < 59 mmol/mol in the preceding 12 months). Analyses were adjusted for the number of patients with diabetes in each general practice and the Welsh Index of Multiple Deprivation.

Results: There was considerable heterogeneity in hypoglycaemic agent spend per patient with diabetes, Median = £289 (IQR 247-343) range £31.1-£1713. Higher total expenditure was not associated with improved glycaemic control B(std) = -0.01 (95%CI -0.01, 0.002) p = 0.13. High-spend practices spent more on SGLT2 inhibitors (16 vs. 9% p < 0.001) and GLP-1 agonists (13 vs. 11% p < 0.001) and less on insulin (34 vs. 42% p < 0.001), biguanides (9 vs. 11% p = 0.001) and sulphonylureas (2 vs. 3% p < 0.001) than low spend practices. There were no differences in the pattern of drug prescribing between high spend practices with better glycaemic control (mean 68% of patients HbA1c <59 mmol/mol) and those with less good metabolic control (mean 58% of patients HbA1c <59 mmol/mol).

Conclusions: Spend on hypoglycaemic agents is highly variable between practices and increased expenditure per patient is not associated with better glycaemic control. Whilst newer, more expensive agents have additional benefits, in individuals where these advantages are more marginal widespread use of these agents has important cost implications.

Keywords: HbA1c; Hypoglycaemic agents; cost; primary care.

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Figures

FIGURE 1
FIGURE 1
Scatter plot of proportion of patients with a HbA1c below 59 mmol/mol and average cost per patient with diabetes
FIGURE 2
FIGURE 2
(a) Box Plot of Total cost per patient with a HbA1c by Quadrant. (b) Box Plot of proportion of patients with a HbA1c <59 mmol in the last 12 months by Quadrant. (c) Pie Chart of relative expenditure of hypoglycaemic agent class by Quadrant
FIGURE 4
FIGURE 4
(a) Proportion of Patients with a HbA1c <59 mmol/mol by the percentage of total expenditure on biguanides. (b) Proportion of Patients with a HbA1c <59 mmol/mol by the percentage of total expenditure on sulphonylureas. (c) Proportion of Patients with a HbA1c <59 mmol/mol by the percentage of total expenditure on thiaglitazones. (d) Proportion of Patients with a HbA1c <59 mmol/mol by the percentage of total expenditure on DPPIV inhibitors. (e) Proportion of Patients with a HbA1c <59 mmol/mol by the percentage of total expenditure on SGLT2 inhibitors. (f) Proportion of Patients with a HbA1c <59 mmol/mol by the percentage of total expenditure on GLP‐1 agonists. (g) Proportion of Patients with a HbA1c <59 mmol/mol by the percentage of total expenditure on insulin
FIGURE 3
FIGURE 3
Practices spending more than £500 per patient – % expenditure of total
FIGURE 5
FIGURE 5
Cubic Splines analysis of the proportion of patients with a HbA1c <59 mmoL/L in the last 12 months against price per patient
See this image and copyright information in PMC

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