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WOONSOCKET, R.I. — A new CVS Caremark Corp. study found that doctors didn’t adhere to the American Diabetes Association/European Association for the Study of Diabetes consensus guidelines for recommended treatment in 35% of cases involving over 250,000 newly diagnosed diabetes patients.
CVS Caremark said Thursday that the research also revealed that patients, payers and the health care system might be paying an extra $420 million annually for the newly initiated treatment because the guidelines not being followed recommend the use of generic medications rather than more expensive branded drugs.
Published this week in the American Journal of Medicine, the study was conducted by researchers from CVS Caremark, Harvard University and Brigham and Women’s Hospital.
The review examined pharmacy claims of 254,000 patients who were newly started on a diabetes medication between Jan. 1, 2006, and Dec. 31, 2008. The research found more than a third of initial treatment regimens for diabetes did not include the ADA’s recommended first-line drug, a generic.
"While 65% of the patients we studied received care consistent with the ADA consensus statements, our results highlight remaining gaps between practice recommendations and contemporary pharmacotherapy for diabetes mellitus (type 2)," researchers wrote.
The researchers reviewed how doctors are treating newly diagnosed patients through an intensive review of CVS Caremark’s claims data to learn more about the clinical practices for patients prescribed oral medications as part of their treatment. Because there is substantial price difference between generic and branded medications, the researchers said a look at the economics of treatment was in order, according to CVS Caremark.
Pharmacy claims they reviewed indicated that patients treated with generics spent an average of $116.10 over six months versus $677.20 for the more expensive therapies. That’s a difference of $560 per patient for six months, or $1,120 per patient per year.
"We found significant variability in clinical practice for treating patients with diabetes," stated Troy Brenan, CVS Caremark executive vice president and chief medical officer and head of the research collaboration with Harvard and Brigham and Women’s. "As we look for ways to rein in the cost of health care, we need to look at how physicians apply practices such as the ADA-recommended consensus guidelines because they align clinical effectiveness with cost-effective prescribing."
Type 2 diabetes has become a critical health issue globally. In the United States, over 20 million people have diabetes, and the number of Americans with the disease is expected to surgey 165% by 2050. Treatment of diabetes in the United States is estimated to cost $200 billion annually.
"We felt it was important to look at how the guidelines were being followed to review the quality of care for patients with diabetes who were newly initiating drug therapy. However, because the guidelines recommend generics as a way to provide cost-effective quality care, the economics of this review were impossible to ignore. That makes this study the first, to our knowledge, to define the fiscal implications of therapeutic choices in a large population of patients with diabetes," noted the study’s senior author, Niteesh Choudhry, associate physician in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women’s Hospital and associate professor at Harvard Medical School.
"With approximately 2 million new cases of diabetes each year, if the medication patterns and insurance coverage for our cohort is representative of the U.S. population, an excess expenditure of $1,120 per patient per year would translate to more than $420 million in additional direct medication costs for diabetes therapy outside the established consensus guideline recommendations," Choudhry added. "Because the prevalence of diabetes is increasing quite dramatically, the potential savings from improved adherence to these recommendations could far exceed these estimates."
