Comments on: Are Actos and Avandia to blame for rising diabetes costs? http://www.kevinmd.com/blog/2008/11/are-actos-and-avandia-to-blame-for.html Tue, 14 Feb 2012 19:56:00 +0000 hourly 1 By: Dr. Matthew Mintzhttp://www.kevinmd.com/blog/2008/11/are-actos-and-avandia-to-blame-for.html#comment-87971 Dr. Matthew Mintz Fri, 07 Nov 2008 02:55:00 +0000 http://clients.emmense.com/kevinmd/2008/11/are-actos-and-avandia-to-blame-for-rising-diabetes-costs.html#comment-87971 Mr. Medsaver,<br/>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).<br/>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. 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.

]]> By: Mr. MedSaverhttp://www.kevinmd.com/blog/2008/11/are-actos-and-avandia-to-blame-for.html#comment-87969 Mr. MedSaver Fri, 07 Nov 2008 01:14:00 +0000 http://clients.emmense.com/kevinmd/2008/11/are-actos-and-avandia-to-blame-for-rising-diabetes-costs.html#comment-87969 In my opinion, here are the main pharmacoeconomic problems with treating diabetes:<br/><br/>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.<br/><br/>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.<br/><br/>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). 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).

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