The impact of sodium glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists on insulin utilisation and costs in Australia: a national retrospective observational cross-sectional study.

Background

Global insulin requirements for type 2 diabetes were predicted to increase by more than 20% from 2018 to 2030. However, this did not anticipate the rapid increase in use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors that has occurred over recent years. The current study aims to examine changes in insulin utilisation and costs in Australia from 2003 to 2023.

Methods

We conducted a large-scale observational study of national insulin utilisation and expenditure in Australia from 2003 to 2023 using the Australian Pharmaceutical Benefits Scheme. The proportion of insulin-treated people with type 2 diabetes between 2013 and 2023 was estimated using National Diabetes Services Scheme data. Joinpoint models and interrupted time series analysis were used to examine utilisation trends.

Findings

Insulin utilisation (units of insulin per person with diabetes) increased by an average of 2.71% per annum (95% CI 1.97, 3.73) from 2003 to 2015, then fell by 2.70% per annum (95% CI -4.55, -1.39) from 2015 to 2023. The proportion of insulin-treated people with type 2 diabetes increased by 1.00% per annum (95% CI 0.81, 1.25) from 2013 to 2020, then fell by 0.66% per annum (95% CI -1.62, -0.04) from 2020 to 2023. A 43% reduction in inflation-adjusted insulin expenditure was observed between 2015 and 2023 due to a combination of reduced utilisation and reduction in the price of insulin glargine.

Interpretation

Projected global insulin requirements and costs may be less than previously anticipated if reduced use of insulin in Australia is similarly observed in other countries.

Funding

No funding was received for this study.

Informations de copyright

© 2024 The Author(s).

Déclaration de conflit d'intérêts

PSH: Member of the Pharmaceutical Benefits Advisory Committee (PBAC). This work is independent of PBAC and does not reflect the views of PBAC. President-Elect of the Endocrine Society of Australia (ESA). This work is independent of ESA and does not reflect the views of ESA. AE: declares no competing interests. AWR: Speaker Honoraria from Boehringer Ingelheim and Astra Zeneca, paid to a University Research Account; ST: Guest discussant at the Drug Utilisation Subcommittee (DUSC) of PBAC. This work is independent of DUSC and does not reflect the views of DUSC. Grant support from MRFF CVD Mission, paid to Monash University, independent of this work; travel and meeting support from Monash University CCRET, independent of this work. EZ: declares no competing interests. SZ: has received payment to the institution (Monash University) from Eli Lilly Australia, Boehringer-Ingelheim, CSL Sequiris, AstraZeneca, Novo Nordisk, Sanofi and Moderna for consultancy work and travel and accommodation support from Eli Lilly and Novo Nordisk, all independent of this work. Funding from NHMRC, Australian Government—Department of Health and Aged Care, JDRF Centre of Excellence and MRFF, all independent of this work.