Unwavering Costs Fuel Need For New Diabetes Treatment Paradigm

Huang

The total costs of diagnosed diabetes have risen to $327 billion in 2017 from $245 billion in 2012, when the cost was last examined, according to the American Diabetes Association.

This figure represents a 26% increase over a five-year period. The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity.

Failure to control or slow the changing costs of diabetes care is a critical problem, according to Elbert Huang, MD, professor of Medicine at The University of Chicago. “Rising drug prices permeates all areas of medicine, and diabetes is no different,” Huang says.

Huang blames both policy makers-who he says have failed to commit resources to prevent diabetes-as well as the multitude of high-cost brand name drugs for diabetes management. “These drugs help, but they’re extremely expensive and will all be brand names for a long time,” he says. The current state of drug pricing, he says, “is an abject failure of policy makers to develop a comprehensive approach to tackling prices.”

In a 2009 study, Huang and his colleagues wrote that: “The diabetes population and the related costs are expected to at least double in the next 25 years. Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened health care system.”

Main culprit

A chief culprit behind burgeoning diabetes care expenses is the escalating cost of medications, especially insulin, says Huang, who also director of the Center for Chronic Disease Research and Policy, section of General Internal Medicine at The University of Chicago.

“Insulin’s an amazing drug, but its price has skyrocketed,” he says. In fact, it has more than tripled in price between 2002 and 2013, from $231 per patient to $736 a year per patient  according to a recent JAMAstudy. The increase reflected rising prices for a milliliter of insulin, which climbed 197% from $4.34 per to $12.92 during the same period. Meanwhile, the amount spent by each patient on other diabetes medications fell 16%, to $502 from $600, according to the study.

In 2013, the expenditure on insulin was significantly more than the combined expenditure on all other antihyperglycemic medications of $502.57, according to a JAMAstudy. The mean price per milliliter of insulin increased by 197% from $4.34 per milliliter in 2002 to $12.92 per milliliter in 2013.

Humulin N and Novolin N (both brand names for the same drug, called insulin NPH. Insulin NPH is an intermediate-acting insulin) increased from approximately $25 per prescription in 1985 to nearly $300 in 2016, while long-acting insulins jumped from about $100 per prescription in 2007 to almost $400 in 2016, according to a May 18, 2018, report.

However, spiraling pharmaceutical costs are just part of the story, according to Tim Dall, managing director for Life Sciences Consulting at IHS Markit. A large portion of diabetes costs are directly related to the condition itself. However related issues, such as heart disease and diabetic ulcers, or comorbidity of diabetes, also increase costs through prolonged hospitalization, among other things, Dall says.      

According to a Tufts Medical Center study, many diabetics with multiple chronic comorbidities have poor diabetes outcomes and excess emergency room visits and 30-day hospital readmissions, adding $15 billion nationally in in potentially unnecessary healthcare costs. The study also showed that reducing emergency department visits and 30-day readmissions in patients with diabetes could yield substantial savings nationally-approximately $15 billion annually.

Approximately half of adults with diabetes have at least one comorbid chronic disease, while 40% of elderly adults with diabetes have at least four, according to Right Medicine.

Health expenditure on diabetes and its complications is set to rise 19% annually until 2040, to reach $802 billion, according to a March 31, 2018, report.

While Huang notes that there are a number of innovations in the pipeline, such as new technologies to monitor sugar and methods for delivering insulin, virtually none will lower overall costs. “They’re all new and expensive; one more so than the last. I’ve studied many of them, and they all increase the cost of care,” he says.

Chuck Green has covered healthcare for more than 10 years.