A Survey On The Coverage Rate Of The Hopoglycemic Agents In The National Essential Medicine List And Drug Cost-effectiveness Analysis During The Course Of Treat-to-target Therapy Among Patients With Type2Diabetes In Beijing Communities

ObjectiveTo investigate the coverage rate of the hypoglycemic agents in national essential medicine list, the reasons for which the patients changed the hypoglycemic agents, and the costs of medicines among patients with type2diabetes mellitus (T2DM) in Beijing communities.MethodsA total number of1001patients with T2DM were enrolled from five community health service centers in Beijing. The five health service centers were in Pingguoyuan, Yuetan, Huaxiang, Longshan and Huangcun communities respectively. Questionaires and physical examination were conducted among them. HbAlc was measured at a central laboratory. Then after the patients were followed up for1year, the data of the characteristics of the patients, the proportion of the patients with HbAlc less than7%, the coverage rate of the hypoglycemic agents, the reasons for which the patients changed the drugs, and the costs of medicines were performed to analysis.Results1. According to the baseline data, the proportion of the patients with HbAlc less than7%in Yuetan(56.3%), Huangcun(44.6%) and Pingguoyuan(33.7%) community health service centers were better than that in Longshan(23.4%) and Huaxiang(2.7%) community health service centers.2. The coverage rates of the seven hypoglycemic agents in national essential medicine list were significantly different (x2=1287.8, P<0.05). The coverage rates of acarbose(46.4%), metformin(41.6%) and human insulin(29.1%) were higher than that of glimepiride(8.6%), glipizide (6.2%), glibenclamide (1%) and animal insulin(0.2%). The coverage rates of using the hypoglycemic agents in national essential medicine list were also singnificantly different in five community health service centers. The highest rate of using the hypoglycemic agents in national essential medicine list was in Longshan center (95.1%). The coverage rate of using the hypoglycemic agents in national essential medicine list in2012(90.4%) was significantly higher than that in2009(45.0%).3. After the1year follow-up, the proportion of the patients with HbAlc less than7%(53.6%) was higher than that at baseline(33.6%). The coverage rates of acarbose(49.7%), metformin(36.3%) and insulin(30.4%) were also higher than that of glimepiride(6.3%), glipizide (2.2%), glibenclamide(0.4%) and animal insulin(0.0%). There were no significant differences among the other six antidiabetic drugs except glipizide in national essential medicine list between the two stage. The coverage rate of glipizide was lower after the1year follow-up(2.2%) than that at baseline(6.2%).4. There were23.6%and27.2%of patients who changed the drug therapy after6and12months follow-up. The main reason that patients changed the antidiabetic drugs was the poor blood glucose control (68.8%). The second reason was personal factors(26.5%). The ratio of the patients who changed the sulfonylureas(51.1%) was the biggest during the1year follow-up. Though there were significant differences in the ratio of the reasons that the patients changed the drugs, bad control of glucose, personal factors and drug adverse reaction were the main reasons when the therapies were changed.5. During the follow-up, the DDDs of the drugs from high to low was human insulin, acarbose, metformin, glimepiride, glipizide, glibenclamide and animal insulin respectively. The DDDc of the drugs from high to low was acarbose, human insulin, glimepiride, metformin, animal insulin, glipizide and glibenclamide. Top3drugs in order of the PDDs from high to low were acarbose, metformin and human insulin respectively. Top3drugs in order of the PDDc from high to low were glimepiride, acarbose, and human insulin. Among the sixteen kinds of drugs, the frequence of using gliquidone was higher and the average cost was lower than the other antidiabetic drugs not in national essential medicine list.6. Among the patients whose HbAlc were less than7%and used only one antidiabetic drug with no chang during the course of therapy, the costs of using the antidiabetic drugs in national essential medicine list in2009were significantly lower than that in2012. Among the patients whose HbAlc were less than7%and used two or more kinds of drugs with no chang during the course of therapy, the costs of using the antidiabetic drugs combined with insulin was higher than that of using combined with metformin.Conclusion1. The hypoglycemic agents in national essential medicine list in2012could meet the current need of residents with type2diabets mellitus better than that in2009in Beijing communities.2. The patients in Beijing communities were liable to change the drug therapy by personal reasons.3. The DDDs and DDDc of metformin were better than that of the other antidiabetic drugs in national essential medicine list.4. The patients who used antidiabetic drugs combined with human insulin should spend more than those used antidiabetic drugs combined with metformin.5. Though gliquidone has not been listed in the national essential medicine catalogue, it’s frequence of application was higher and it’s average daily cost was lower than the other the other antidiabetic drugs not in national essential medicine list.