Advertisement

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. Hsu
Original Research Article

Abstract

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.

Methods

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.

Results

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.

Conclusions

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.

Notes

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.

Funding

No source of funding was used for this study.

References

  1. 1.
    Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med. 1997;14(Suppl 5):S1–85.PubMedGoogle Scholar
  2. 2.
    Boyc KS, Yurgin N, Lage MJ. Trends in the prescription of antidiabetic medications in France: evidence from primary care physicians. Adv Ther. 2007;24:803–13.CrossRefGoogle Scholar
  3. 3.
    Mazzaglia G, Yurgin N, Boye KS, et al. Prevalence and antihyperglycemic prescribing trends for patients with type 2 diabetes in Italy: a 4-year retrospective study from national primary care data. Pharmacol Res. 2008;57:358–63.CrossRefGoogle Scholar
  4. 4.
    Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414:782–7.CrossRefGoogle Scholar
  5. 5.
    Walley T, Hughes D, Kendall H. Trends and influences on use of antidiabetic drugs in England, 1992–2003. Pharmacoepidemiol Drug Saf. 2005;14:769–73.CrossRefGoogle Scholar
  6. 6.
    Baviera M, Monesi L, Marzona I, et al. Trends in drug prescriptions to diabetic patients from 2000 to 2008 in Italy’s Lombardy Region: a large population-based study. Diabetes Res Clin Pract. 2011;93:123–30.CrossRefGoogle Scholar
  7. 7.
    Patel H, Srishanmuganathan J, Car J, Majeed A. Trends in the prescription and cost of diabetic medications and monitoring equipment in England 1991–2004. J Public Health (Oxf). 2007;29:48–52.CrossRefGoogle Scholar
  8. 8.
    International Diabetes Foundation. IDF diabetes ATLAS Seventh Edition. 2015. pp. 50–1.Google Scholar
  9. 9.
    Health Promotion Administration. The origin of world diabetes day and domestic propaganda response. 2018. https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1090&pid=6426. Accessed: 11 Aug 2018.
  10. 10.
    Zhang L, Zhang M, Lv Q, Tong N. Efficacy and safety of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and moderate renal function impairment: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2018;140:295–303.CrossRefGoogle Scholar
  11. 11.
    Thewjitcharoen Y, Yenseung N, Malidaeng A, et al. Effectiveness of long-term treatment with SGLT2 inhibitors: real-world evidence from a specialized diabetes center. Diabetol Metab Syndr. 2017;9:96.CrossRefGoogle Scholar
  12. 12.
    Scheen AJ, Paquot N. Metabolic effects of SGLT-2 inhibitors beyond increased glucosuria: a review of the clinical evidence. Diabetes Metab. 2014;40:S4–11.CrossRefGoogle Scholar
  13. 13.
    O’Brien JA, Shomphe LA, Kavanagh PL, Raggio G, Caro JJ. Direct medical costs of complications resulting from type 2 diabetes in the U.S. Diabetes Care. 1998;21:1122–8.CrossRefGoogle Scholar
  14. 14.
    Insurance BoNH. National Health Insurance Annual Statistical Report. 2004. http://www.nhi.gov.tw/Resource/webdata/Attach_8661_1_s92.pdf. Accessed: 11 Aug 2018.
  15. 15.
    Liu SZ, Romeis JC. Assessing the effect of Taiwan’s outpatient prescription drug copayment policy in the elderly. Med Care. 2003;41:1331–42.CrossRefGoogle Scholar
  16. 16.
    WHO. ATC/DDD Index. 2018. https://www.whoccno/atc_ddd_index/. Accessed 11 Aug 2018.
  17. 17.
    Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27:299–309.CrossRefGoogle Scholar
  18. 18.
    Lu CY, Ross-Degnan D, Stephens P, Liu B, Wagner AK. Changes in use of antidiabetic medications following price regulations in China (1999–2009). J Pharm Health Serv Res. 2013;4:3–11.CrossRefGoogle Scholar
  19. 19.
    Lu CY, Zhang F, Lakoma MD, et al. Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study. BMJ. 2014;348:g3596.CrossRefGoogle Scholar
  20. 20.
    Hsu JC, Lu CY, Wagner AK, Chan KA, Lai MS, Ross-Degnan D. Impacts of drug reimbursement reductions on utilization and expenditures of oral antidiabetic medications in Taiwan: an interrupted time series study. Health Policy. 2014;116:196–205.CrossRefGoogle Scholar
  21. 21.
    Lu CY, Soumerai SB, Ross-Degnan D, Zhang F, Adams AS. Unintended impacts of a Medicaid prior authorization policy on access to medications for bipolar illness. Med Care. 2010;48:4–9.CrossRefGoogle Scholar
  22. 22.
    Serumaga B, Ross-Degnan D, Avery AJ, et al. Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study. BMJ. 2011;342:d108.CrossRefGoogle Scholar
  23. 23.
    Shadish RS, Cook TD, Campbell D. Experimental and quasi-experimental designs for generalized causal inference Houghton Mifflin. 2002;171–206.Google Scholar
  24. 24.
    Zhang F, Wagner AK, Soumerai SB, Ross-Degnan D. Methods for estimating confidence intervals in interrupted time series analyses of health interventions. J Clin Epidemiol. 2009;62:143–8.CrossRefGoogle Scholar
  25. 25.
    Heald AH, Livingston M, Bien Z, Moreno GYC, Laing I, Stedman M. The pattern of prescribing of glucose modulating agents for type 2 diabetes in general practices in England 2016/17. Int J Clin Pract. 2018;72:e13080.CrossRefGoogle Scholar
  26. 26.
    Hsu JC, Ross-Degnan D, Wagner AK, et al. Utilization of oral antidiabetic medications in Taiwan following strategies to promote access to medicines for chronic diseases in community pharmacies. J Pharm Policy Pract. 2015;8:15.CrossRefGoogle Scholar
  27. 27.
    Ou HT, Chang KC, Liu YM, Wu JS. Recent trends in the use of antidiabetic medications from 2008 to 2013: a nation-wide population-based study from Taiwan. J Diabetes. 2017;9:256–66.CrossRefGoogle Scholar
  28. 28.
    Hsu JC, Cheng CL, Ross-Degnan D, et al. Effects of safety warnings and risk management plan for Thiazolidinediones in Taiwan. Pharmacoepidemiol Drug Saf. 2015;24:1026–35.CrossRefGoogle Scholar

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

Personalised recommendations