Clinical Drug Investigation

, Volume 38, Issue 12, pp 1125–1133 | Cite as

Replacement Effects and Budget Impacts of Insurance Coverage for Sodium-Glucose Co-Transporter-2 Inhibitors on Oral Antidiabetic Drug Utilization

  • Hsiang-Yin Chen
  • Pei-Yin Chiu
  • Ching-Jun Chang
  • Lih-Ling Tsai
  • Ya-Lan Huang
  • Jason C. HsuEmail author
Original Research Article


Background and Objectives

A new oral antidiabetic drug class, sodium-glucose co-transporter-2 inhibitors (SGLT-2 inhibitors), has been covered by national health insurance in Taiwan since May 2016. This study estimated the impacts of insurance coverage for SGLT-2 inhibitors on the replacement effects of antidiabetic drug use and the overall budget for antidiabetic drugs in Taiwan.


Antidiabetic drugs were divided into nine categories based on the American Diabetes Association guidelines. We retrieved claims data from 2015 to 2017 for all patients diagnosed with diabetes mellitus from the National Health Insurance Research Database. An interrupted time series design and segmented regression were used to estimate the budget impact of insurance coverage for SGLT-2 inhibitors. Three scenarios were designed for the prescribing pattern for SGLT-2 inhibitors: (1) monotherapy, (2) metformin-based (m-based) drug prescriptions, and (3) metformin and sulfonylurea-based (m-s-based) drug prescriptions.


From May 2016 to April 2017, the prescription rate for m-based SGLT-2 inhibitors increased from 0.43 to 3.50%, and the expenditure rate increased from 0.82 to 6.58%. We found that the prescription rates of m-based and m-s-based dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) decreased by 6.23 and 11.51% following the initiation of insurance coverage for SGLT-2 inhibitors, respectively. Furthermore, there was a 5.95% increase in the overall budget impact of antidiabetic drugs 1 year following the initiation of insurance coverage for SGLT-2 inhibitors.


Both the prescription rates and expenditure rates for SGLT-2 inhibitors have increased since they have been covered by national health insurance in Taiwan, which significantly reduced usage of DPP-4 inhibitors but caused the positive growth of overall antidiabetic drug expenditures.


Author Contributions

HYC, LLT, and JCH conceptualized and designed the study. PYC, CJC, and YCL provided suggestions for research design from clinical perspective. HYC collected data, performed analysis, and drafted the manuscript. JCH reviewed all data and revised the manuscript critically for intellectual content. All authors approved the final version for submission.

Compliance with Ethical Standards

Ethics Approval and Consent to Participate

Use of data from the NHIRD for research purpose is exempt from IRB review in Taiwan.

Availability of Data and Material

The authors have obtained nationwide data from 2015 to 2017 for all patients diagnosed with diabetes from the NHIRD. No additional data are available.

Conflict of Interest

The authors have no competing interests.


No source of funding was used for this study.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.National Health Insurance Administration-Kaoping DivisionMinistry of Health and WelfareKaohsiungTaiwan, ROC
  2. 2.School of Pharmacy, College of MedicineNational Cheng Kung UniversityTainanTaiwan, ROC

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