Insulin Costs Rise But Mostly Not Paid For Out-of-Pocket by Patients

MedicalResearch.com Interview with:
Dr. Hui ShaoDr. Hui Shao, MBBS, MHA, PhD
CDC

MedicalResearch.com: What is the background for this study? 

Response: 23.1 million people in the U.S. have diagnosed diabetes and 7.4 million regularly use one or more types of insulin. Spending on insulin accounts for a large portion of the costs associated with diabetes. Affordability of insulin has become a public health concern in recent years as high spending on insulin imposes a large financial burden on the national health care system and is associated with poor adherence and health outcomes.

MedicalResearch.com: What are the main findings?

Response: In this study, we analyzed the recent trends in usage and total payments, and patients’ out-of-pocket (OOP) payments for insulin by type in privately insured Americans (MarketScan Claims database) 2003-2017.  We estimated total payment and out-of-pocket payment for a 30-day/yearly supply of different types of insulin and found that, on average, inflation-adjusted annual total payments for insulin increased yearly by around 6% ($153) between 2003 and 2012 and by around 13% ($592) between 2011 and 2017. Similar increase patterns were observed across insulin types.

The major driver for increases in average total payments for a 30-day supply of insulin were explained by increases in payments for existing products and not by changes in the market share of insulin types. In contrast, out-of-pocket payments increased only marginally, suggesting that the increase in insulin spending was not paid directly by the patient.

MedicalResearch.com: What should readers take away from your report?

Response: The average annual total payment increased substantially during the study period, from $1,982 per year in 2003 to $6,360 per year in 2017 (in inflation-adjusted in 2017$). Total payments for insulin have been increasing since 2003 but were at much higher rates after 2011. In contrast, annual out-of-pocket costs increased only marginally from $390 to $451 during the same period, suggesting that the sharp payment increases were not paid out of pocket by the patient. The payment increase occurred across all insulin types, suggesting a lack of inexpensive alternatives in the insulin market. Even for human insulin, the cheapest form of insulin, the average payment for a 30-day supply caught up with insulin analogs in 2017.                                               

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Our study population is those with private insurance with the fee for service. Additional research is needed to help determine if similar spending patterns are observed in persons with other types of health insurance, especially those with high-deductible plans and those without health insurance.

Further research in this area could also help us determine the cause of rising insulin costs, and inform decision-making at all levels, which could reduce insulin cost, or slow the consistent increase in cost. 

MedicalResearch.com: Is there anything else you would like to add?

Response: There are no additional comments or disclosures. For more information about how the CDC works to prevent and control diabetes visit https://www.cdc.gov/diabetes/index.html.

 Citation: ADA 2019 abstract

Trend in Total Payment and Out-of-Pocket Payment on a Yearly Supply of Oral Antidiabetic Drug Types among U.S. Adults with Private Health Insurance from 2003 to 2016

HUI SHAOMICHAEL LAXYSTEPHEN R. BENOITYILING J. CHENGEDWARD GREGG and PING ZHANG

 

Jun 16, 2019 @ 12:58 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Apple or Pear? Body Shape Not Determined Just by Fat

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Kalypso Karastergiou, MD, PhD Assistant Professor, Medicine, Endocrinology, Diabetes and Bone Disease Diabetes, Obesity and Metabolism Institute Icahn School of Medicine at Mount Sinai     MedicalResearch.com:  What is the background for this study?   Response: Multiple studies, epidemiological as well as clinical, have established that body shape is an important and independent predictor of cardiovascular and metabolic disease risk and ultimately total mortality. Subjects that preferentially store weight in the abdominal area (often described as android, upper-body or apple-shape obesity) are at increased risk, whereas those who preferentially store weight in the lower body, in the gluteofemoral area (gynoid, lower-body or pear-shape), appear to be protected. The former is more common in men, whereas the latter in women, especially premenopausal women.   The overarching questions in the field are:  •What factors determine body shape?  •	Why are subjects with lower-body shape protected?  •	Can we exploit the physiological and pathophysiological mechanisms involved to improve stratification, prevention or treatment of obesity and related diseases?   MedicalResearch.com: What are the main findings?   Response: Up to date, studies in body shape have focused on the distribution of the adipose (fat) tissue.  This report seeks to expand the investigation to other tissues as well. During the period from 1999-2006, 14,005 participants in the National Health and Nutrition Examination Survey (which represents the United States population), 20-69 years old, had a DXA test that allows total and regional estimation of fat, lean and bone tissue mass.   This preliminary analysis shows that body shape is determined by coordinated changes in the head, trunk and limbs that involve the fat, as well as the other tissues.     MedicalResearch.com: What should readers take away from your report?  Response: This is an observational study that doesn’t allow us to draw conclusion as to cause and effect or prediction of future risk. It does suggest that body shape is a whole-body feature with systematic, coordinated changes in all body compartments and tissues.   The observations should be replicated in other populations and in prospective studies.      MedicalResearch.com: What recommendations do you have for future research as a result of this work?  Response: This report generates more questions than it answers.   •	First of all, are there differences in the function of tissues that determine body shape between subjects with upper- versus lower body shape?   •	Which tissues drive differences in physiology and disease risk?   •	Can we identify the underlying molecular pathways?   •	Does any of these pathways represent a viable mechanistic target to prevent or treat disease and improve quality of life?     Dislosures The study is partly funded by grants from the MSHS Translational Science Hub at Icahn School of Medicine at Mount Sinai (KL2TR001435) and the Einstein-Sinai Diabetes Research Center in New York City.     Citation: ADA 2019 abstract  277-OR: Lean Tissues as Novel Determinants of Pear vs. Apple Body Shape and Metabolic Health in Humans KALYPSO KARASTERGIOU Diabetes 2019 Jun; 68(Supplement 1): -.https://doi.org/10.2337/db19-277-OR      <span class="last-modified-timestamp">Jun 11, 2019 @ 7:39 pm</span>    The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Dr. Karastergiou

Kalypso Karastergiou, MD, PhD
Assistant Professor, Medicine, Endocrinology, Diabetes and Bone Disease
Diabetes, Obesity and Metabolism Institute
Icahn School of Medicine at Mount Sinai 

MedicalResearch.com: What is the background for this study?  

Response: Multiple studies, epidemiological as well as clinical, have established that body shape is an important and independent predictor of cardiovascular and metabolic disease risk and ultimately total mortality. Subjects that preferentially store weight in the abdominal area (often described as android, upper-body or apple-shape obesity) are at increased risk, whereas those who preferentially store weight in the lower body, in the gluteofemoral area (gynoid, lower-body or pear-shape), appear to be protected. The former is more common in men, whereas the latter in women, especially premenopausal women.

The overarching questions in the field are:

  • What factors determine body shape?
  • Why are subjects with lower-body shape protected?
  • Can we exploit the physiological and pathophysiological mechanisms involved to improve stratification, prevention or treatment of obesity and related diseases? 

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The Vitamin D and Type 2 Diabetes Study

MedicalResearch.com Interview with:

Anastassios G. Pittas, M.D MS Professor Co-Director, Diabetes and Lipid Center; Tufts University School of Medicine

Dr. Pittas

Anastassios G. Pittas, M.D MS
Professor
Co-Director, Diabetes and Lipid Center;
Tufts Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Observational studies have consistently reported an association between low blood vitamin D level and development of type 2 diabetes. However, whether vitamin D supplementation lowers risk of developing diabetes is not known. We designed and conducted the Vitamin D and diabetes (D2d) study to answer this question.  We randomized 2,423 people with prediabetes to 4,000 IU/day of vitamin D3 or placebo and followed them for new-onset diabetes with blood tests every 6 months for an average of 2.5 years. About 80% of participants had sufficient vitamin D level at baseline (25-hydroxyvitamin D level >= 20 ng/mL). The trial was designed to show a reduction of 25% or more in diabetes risk with vitamin D.

The study was unable to show a reduction of 25% or more. At the end of the study, there was a 12% reduction in risk of developing diabetes with vitamin D, which missed statistical significance (hazard ration 0.88; 95% confidence interval 0.75 to 1.04). In a small subgroup of participants with vitamin D deficiency at baseline (25-hydroxyvitamin D level < 12 ng/mL) there was 62% reduction in risk of diabetes with vitamin D (hazard ration 0.38; 95% confidence interval 0.18 to 0.80).

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Midlife Type 2 Diabetes Mellitus Linked to Increased Risk of Ischemic Stroke

MedicalResearch.com Interview with:
Rongrong Yang, PhD candidate

Tianjin Medical University 

MedicalResearch.com: What is the background for this study?

Response: Worldwide, cerebrovascular disease (CBD) and type 2 diabetes mellitus (T2DM) are common disorders that have become among the top ten leading causes of death, killing approximately 8 million people in 2016. Both T2DM and CBD are complex genetic and lifestyle-related disorders. Genetic and familial environmental factors (e.g. foetal environment, maternal smoking and childhood socioeconomic status) have been shown to be involved in the development of both conditions. Accumulating evidence from previous studies suggests that T2DM is independently associated with an increased risk of CBD, especially ischemic CBD.

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