American Diabetes Association
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Factors Contributing to the Rising National Cost of Glucose-Lowering Medicines for Diabetes During 2005–2007 and 2015–2017

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posted on 2020-07-31, 18:00 authored by Xilin Zhou, Sundar S. Shrestha, Hui Shao, Ping Zhang

We examined changes in glucose-lowering medication spending and quantified the magnitude of factors that are contributing to these changes.


Using the Medical Expenditure Panel Survey, we estimated the change in spending on glucose-lowering medications during 2005–2007 and 2015–2017 among adults aged 18 years or older with diabetes. We decomposed the increase of total spending by medication groups: for insulin by human and analog; and for non-insulin by metformin, older, newer, and combination medications. For each group, we quantified the contributions by the number of users and cost-per-user. Costs were in 2017 US dollars.


National spending on glucose-lowering medications increased by $40.6 billion (240%), of which insulin and non-insulin medications contributed $28.6 billion (169%) and $12.0 billion (71%), respectively. For insulin, the increase was mainly associated with higher expenditures from analogs (156%). For non-insulin, the increase was a net effect of higher cost for newer medications (+88%) and decreased cost for older medications (-34%). Most of the increase in insulin spending came from the increase in cost-per-user. However, the increase in the number of users contributed more than cost-per-user in the rise of most non-insulin groups.


The increase in national spending on glucose-lowering medications during the past decade was mostly associated with the increased costs for insulin, analogs in particular, and newer non-insulin medicines; and cost-per-user had a larger effect than the number of users. Understanding the factors contributing to the increase helps identify ways to curb the growth in costs.