Background Medication costs are the primary driver of increasing medical expenditure on diabetes. We explore trends in pharmaceutical expenditure on diabetes between 2011 and 2015, examining the impact of newer blood glucose-lowering medications, and estimating the effect of cost-containment measures implemented during this time.
Methods Data from a national pharmacy claims database were analysed. Patients dispensed items used in the treatment or management of diabetes were identified. Total expenditure associated with diabetes was calculated by extracting data on all diabetes-related items dispensed to eligible patients. Costs were categorised into two groups; diabetes-specific items include items used directly in the treatment of diabetes and other items include all other condition-related. The impact of two specific cost-containment measures, co-payments and reference pricing, implemented over the study period were assessed using segmented linear regression analyses of interrupted time series.
Results Total expenditure varied over the study period, peaking at €216,994,441 in 2012. Expenditure on diabetes-specific items increased steadily by 18% reaching €153,621,477 in 2015, with blood glucose-lowering medications accounting for 73% of this increase. During the same period, expenditure on other items decreased by 32% to €50,835,856. The introduction of reference pricing for atorvastatin in November 2013 resulted in immediate costs savings of €2.4 million per yearly quarter (level change p<0.001).
Conclusion The increasing costs of blood glucose-lowering medications overshadows the effect of cost-containment measures. Innovative policies are required to ensure high quality diabetes care can be provided at an equitable, affordable and sustainable rate.
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