Diabetic Treatment Cost Doubles as Insulin Use Increases

Diabetics are using more insulin and paying about twice as much for the treatment than a decade ago, even though questions remain about whether the newer forms of the drug are more effective, Yale University researchers said.

Out-of-pocket costs for each insulin prescription rose to $36 in 2010 from $19 in 2000 as patients switched to newer forms of insulin that cost two to four times more than older versions, research published in the Journal of the American Medical Association found. The percentage of diabetics filling insulin prescriptions rose to 15 percent from 9.7 percent.

The newer treatments, called insulin analogs, offer comparable blood sugar control to older drugs, though are more convenient and cost more, said Kasia Lipska, the lead study author. The research, however, found only a slight benefit at reducing severe nighttime hypoglycemia, or low blood sugar, a condition the newer drugs are designed to prevent.

“What we’re showing is we kind of universally switched over to the more expensive option without that much convincing data about the benefits of this transition,” Lipska, an instructor of medicine at Yale University School of Medicine in New Haven, Connecticut, said in an interview. “Given that we are trying to contain our health-care costs, when we see these types of shifts we have to know whether this is worth it.”

More studies are needed to compare the different types of diabetes medicines, she said.

29 Million Diabetics

Diabetes, which results when the body doesn’t use insulin properly or doesn’t make the hormone, is the seventh-leading cause of death in the U.S. Insulin is a hormone secreted by the pancreas that helps the body control blood sugar. Type 2, in which the body doesn’t use insulin properly, accounts for about 95 percent of diabetics, whose numbers continue to increase.

More than 29 million people in the U.S. have diabetes, an increase from 26 million estimated in 2010, according to a report released yesterday by the U.S. Centers for Disease Control and Prevention.

Newer treatments offer patients more predictable blood sugar control and are worth the higher costs, said Laurence Kennedy, an endocrinologist and chairman of the Department of Endocrinology, Diabetes and Metabolism at the Cleveland Clinic in Ohio, who wasn’t involved in the Yale study released yesterday.

He said that previous research has shown a benefit in reducing hypoglycemia in comparison with older insulins, which is one of the reasons he prefers to prescribe his patients insulin analogs.

Earlier Treatment

Most endocrinologists think Type 2 diabetes patients should be given insulin treatment sooner rather than later. In the past, patients were resistant because they didn’t like the idea of injections or they thought it meant a bad outcome, he said. Now with smaller needles, ease of use and better patient education more are willing to take insulin.

“There is no doubt that the analog insulins, particularly the longer-lasting insulins, have helped patients with Type 2 diabetes accept insulin as a very worthwhile treatment,” he said in a telephone interview.

Still, prescription drug prices have been surging and insulin products for diabetes have had some of the bigger price increases, according to a survey conducted for Bloomberg News by Los-Angeles based DRX, a provider of comparison software for health plans. The survey, reported in April, found that since late 2007, U.S. prices have jumped at least 160 percent for various forms of Eli Lilly & Co. (LLY)’s Humulin.

Insulin analogs include Sanofi’s (SAN) Lantus, Novo Nordisk A/S (NOVOB)’s Novolog and Lilly’s Humalog.

Claims Data

The Yale researchers reviewed claims data from people in the U.S. with Type 2 diabetes who were privately insured. They examined trends in insulin use, out-of-pocket costs and episodes of severe low blood sugar from 2000 through 2010.

Over the study period, the percentage of people with diabetes filling an insulin prescription rose to 15 percent in 2010 from 9.7 percent in 2000. The type of insulin diabetics were prescribed shifted from 96 percent for human synthetic insulin in 2000 to 92 percent for insulin analogs in 2010.

Lipska said over the study, rates of severe low blood sugar, called hypoglycemia, only declined slightly and weren’t statistically significant.

To contact the reporter on this story: Nicole Ostrow in New York at nostrow1@bloomberg.net

To contact the editors responsible for this story: Reg Gale at rgale5@bloomberg.net Angela Zimm, Andrew Pollack

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