Evaluation of Pattern of Oral Hypoglycaemic Agents Usage and their Cost among Type-2 Diabetic Patients in a Tertiary Care Teaching Hospital

Abstract

Introduction: Diabetes mellitus is a chronic disorder requiring life-long treatment to maintain the blood glucose levels. The total economic cost of diabetes was $245 billion in 2012. In India, one spends approximately 20% of their income for the treatment of diabetes per year which affects the patients’ compliance and there is also a huge discrepancy in the cost of drugs. Aim: To study the pattern of oral hypoglycaemic agents’ usage among Type-2 diabetic patients and also compare their costanalyses, to determine the percentage cost variation and to arrive at the economical oral hypoglycaemic drugs. Materials and Methods: This observational cross-sectional study was conducted among Type-2 diabetic patients attending the diabetology department over a period of three months in a tertiary care teaching hospital. Three hundred prescriptions (both old and new cases) were used to extract information like number of oral hypoglycaemic agents prescribed, their strength, duration, price, generic or branded and manufacturer’s details. The percentage cost variation was calculated using the cost difference between the highest and lowest priced brand. Data were analysed using chi-square test (to elicit the association between duration of treatment and mono/combination therapy) using SPSS Software 20.0 version. Results: Majority of the patients (59.3%) were above 50 years of age with female preponderance (54%). Branded drugs were prescribed to 87.7% of patients. 85.3% received combination therapy (Metformin, Glimepiride, Gliptins) and 14.7% received monotherapy (Metformin, Teneligliptin). Commonly used monotherapy was metformin with cost of about 2.75 INR/day and the combination therapy was teneligliptin and metformin with a minimum cost of 13.31 INR/day. The most economical combination therapy was found to be of glimepiride and metformin with cost of 8.25 INR/day. Percentage cost variation of different brands ranged from 5.88% to 177.57%. There was a significant association between combination therapy and disease duration greater than five years (p<0.01). Conclusion: It was observed from this study that there is a wide variation in cost of different drugs. Hence, it is necessary for regulatory authorities to regulate the wide variation that exists among the drug cost. This study will be useful to the clinicians to choose most economic drugs without change in quality of treatment in diabetic patients. Metformin is the most commonly used economic monotherapy and combination therapy was Glimepiride+Metformin.

Keywords

• anti-diabetic medications
• combination therapy
• cost analysis
• monotherapy
• pharmacoeconomics