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Prescribing costs of hypoglycaemic agents and associations with metabolic control in Wales; a national analysis of primary care data

Taylor, Peter N. ORCID:, Siah, Qi Zhuang, Marei, Omar, McDade‐Kumar, Mia, Rachedi, Nasser, Bracchi, Robert, Boldero, Richard, Haines, Kath, Ali, Mohammed Alhadj, French, Robert ORCID: and Dayan, Colin M. ORCID: 2022. Prescribing costs of hypoglycaemic agents and associations with metabolic control in Wales; a national analysis of primary care data. Diabetic Medicine 39 (9) , e14908. 10.1111/dme.14908

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Aims: There has been a dramatic increase in hypoglycaemic agent expenditure. We assessed the variability in prescribing costs at the practice level and the relationship between expenditure and the proportion of patients achieving target glycaemic control. Methods: We utilized national prescribing data from 406 general practices in Wales. This was compared against glycaemic control (percentage of patients achieving a HbA1c level < 59 mmol/mol in the preceding 12 months). Analyses were adjusted for the number of patients with diabetes in each general practice and the Welsh Index of Multiple Deprivation. Results: There was considerable heterogeneity in hypoglycaemic agent spend per patient with diabetes, Median = £289 (IQR 247–343) range £31.1–£1713. Higher total expenditure was not associated with improved glycaemic control B(std) = −0.01 (95%CI –0.01, 0.002) p = 0.13. High‐spend practices spent more on SGLT2 inhibitors (16 vs. 9% p < 0.001) and GLP‐1 agonists (13 vs. 11% p < 0.001) and less on insulin (34 vs. 42% p < 0.001), biguanides (9 vs. 11% p = 0.001) and sulphonylureas (2 vs. 3% p < 0.001) than low spend practices. There were no differences in the pattern of drug prescribing between high spend practices with better glycaemic control (mean 68% of patients HbA1c <59 mmol/mol) and those with less good metabolic control (mean 58% of patients HbA1c <59 mmol/mol). Conclusions: Spend on hypoglycaemic agents is highly variable between practices and increased expenditure per patient is not associated with better glycaemic control. Whilst newer, more expensive agents have additional benefits, in individuals where these advantages are more marginal widespread use of these agents has important cost implications.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: License information from Publisher: LICENSE 1: URL:
Publisher: Wiley
ISSN: 0742-3071
Date of First Compliant Deposit: 20 July 2022
Date of Acceptance: 27 June 2022
Last Modified: 10 May 2023 21:43

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