How fitting that in these cost-conscious times, some experts are questioning whether pricey new diabetes drugs like Actos and Byetta actually provide more bang for the buck than older, cheaper ones. Their research dovetails nicely with new diabetes treatment guidelines that support trying less expensive drugs to lower blood sugar levels first and only moving on to more expensive drugs if the cheaper ones don't do the trick.
Some of the newer, costlier drugs have been touted because they're more convenient, have fewer side effects, or provide better control over blood sugar levels. But they're also up to 11 times as expensive as the typical $29 per 30-day prescription for metformin, a generic version of Glucophage, which was approved in 1995. The benefits may not outweigh the costs in some cases, these researchers argue, particularly since it's not clear that the new drugs improve heart or kidney function in the long term.
The Stanford study, which was published Monday in the Archives of Internal Medicine, comes on the heels of new diabetes treatment guidelines issued last week by the American Diabetes Association and the European Association for the Study of Diabetes. The guidelines suggest a stepped approach to treatment, starting with metformin and lifestyle changes immediately after diagnosis. (Here's a checklist of what to do after being diagnosed.) If after three months blood sugar levels are still too high, then insulin or a sulfonylurea drug, both older generic drugs, should be the preferred next step. If blood sugar is still too high after an additional three months, then the ADA says, OK, now try Actos, a brand-name drug with a $160 price tag per 30-day prescription, or some of the other new drugs. The guidelines no longer recommend the use of Avandia, a drug in the same class as Actos, following reports that link it to higher heart attack risk.
"In our considered opinion, these newer drugs don't have any particular advantage," says David Nathan, the director of the Diabetes Center at Massachusetts General Hospital who chaired the panel that developed the recommendations.
Nathan discussed Byetta as an example. Approved by the FDA in 2005, Byetta has received plenty of attention because it not only improves glycemic control but also helps patients lose weight. At $202 per month, though, it's nearly 10 times as expensive as metformin. According to Nathan, typical weight loss with Byetta is just 4 to 6 pounds, and 40 percent of people complain of nausea when taking it. It requires twice-daily injections, he says, and doesn't lower blood glucose levels as much as some other drugs.
I've written in the past about doctors' cluelessness when it comes to the cost of the treatments they prescribe. That's got to change, says Nathan. "Many physicians don't like to think about costs," he explains. "But we all have a responsibility to think about the bottom line."