Matthew Mintz takes exception to the criticism that Actos and Avandia are taking. This class of diabetes medication, known as thioglitazones, have been much maligned due to possibly dangerous adverse outcomes combined with only a modest benefit.
Dr. Mintz wonders why the newer insulins aren’t scrutinized as carefully:
The TZDs (Avandia and Actos) did peak in 2005 at 34%, but their use in 2007 is now the same as it was back in 2001 and prescribed at 28% of visits. The money spent doubled from about $1.9 billion in 2001 to $4.2 billion in 2007.Per the study’s estimates TZD’s, Lispro and Lantus all cost $160, $156 and $123 respectively, which is not that much different. Thus, of the extra $5.8 billion dollars we are paying more for diabetes, $2.3 billion is coming from the TZD’s, and $1.9 billion is coming from the newer insulins.
One reason is that the branded insulins are not associated with the adversity that Avandia has brought to the thioglitizones. The long-acting insulins like Lantus and Levemir also provide a convenience factor for patients, which helps with compliance.
The jury is still out on the cost-effectiveness of Januvia and Byetta. The weight loss component of Byetta is appealing, but these drugs are still too new to make a decision on whether they are worth the price or not.
topics: diabetes, avandia
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{ 2 comments }
In my opinion, here are the main pharmacoeconomic problems with treating diabetes:
1. Like with most other conditions, doctors forget about using older, less expensive generic drugs first. Before all of the health scares, I saw numerous physicians using Avandia as a first-line therapy in newly-diagnosed diabetics.
2. Much in the same way, I think doctors are too eager to jump to the latest, ridiculously expensive brand name drug to hit the market.
3. The treatment of diabetes currently relies heavily on biologic drugs (insulin, Byetta, etc.). Because no approval process is in place to bring generic biologics to the market, the costs of these drugs will only increase higher and higher (as all brand name drugs do).
Mr. Medsaver,
This study shows that doctors are actually using the older, generic medications first. Metformin and sulfonylureas remain to most prescribed medications for type 2 diabetes. What changed over the past decade was that doctors started using metformin first over sulfonylureas. The problem is that both these older drugs fail over time. The UKPDS showed that almost 1/2 of diabetics taking either pill will lose control (need more drugs) by 3 years, and most will fail by 6 years. Thus, most diabetics are unable to get by with just generic pills. In addition, though sulfonylureas are effective and cheap as dirt, they cause significant hypoglycemia (low blood sugar) which can be a serious side effect, cause weight gain, and have a boxed warning that looks much scarier than Avandia’s (most people forget this, since it is such an old drug and used so commonly).
The question is really whether or not we use older,cheaper pills and insulins that work, but may have more side effects and/or are more inconvenient to take, or do we use newer pills and insulins that might have a better side effect/convenience profile, but are much more expensive.
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