Metformin plus vitamin B12 supplementation saves between $7 and $42 per patient per year relative to placebo when the drug plus supplementation strategy is used to prevent progression from prediabetes to diabetes, an updated cost analysis of the Diabetes Prevention Program (DPP) and the Diabetes Prevention Program Outcomes Study (DPPOS) suggests.
“Approximately 86 million patients in the United States have prediabetes, and 0.7% of them receive metformin,” study authors under lead author Nicholas Carris, PharmD, University of South Florida, College of Pharmacy, Tampa, observe. “Therefore, increasing the use of metformin with vitamin B12 supplementation in patients with prediabetes represents one opportunity to improve patient care and to reduce healthcare costs nationally,” they add.
The retrospective analysis was published online June 5 in the Journal of the American Pharmacists Association.
The purpose of the analysis was to update the 2012 costs of treating patients to prevent diabetes with metformin and to redress the omission in the earlier analysis of not including vitamin B12 supplementation in the analysis. Metformin has the potential to induce vitamin B12 deficiency, and the American Diabetes Association now recommends patients taking metformin be monitored for vitamin B12 deficiency.
“The 2012 DPP/DPPOS report’s primary analysis was performed on a 10-year time horizon from a health system perspective, which includes only direct medical costs,” study authors observe. “The principal findings of the 2012 DPP/DPPOS report were that lifestyle intervention was the most cost-effective option for preventing diabetes and that metformin was a cost-saving option.”
Since 2012, however, the cost of acquiring metformin has been steadily decreasing by between $40 and $110 a year.
Thus, Dr. Carris and colleagues adjusted the per capita cost of acquiring metformin in more recent years and balancing these costs out by the more costly requirement to monitor patients for vitamin B12 deficiency.
“The estimated per capita health system cost of the metformin group changed from the original analysis of $29,666 (2012 DPP/DPPOS report) depending on the metformin cost analyzed: $29,337 (-$329, $0 metformin + vitamin B12), $29,532 (-$134, $40 metformin + vitamin B12), or $29,687(+$21, $72 metformin + vitamin B12),” study authors report.
To treat vitamin B12 deficiency, it costs only $28 per patient per year to the healthcare system overall, researchers add.
Furthermore, taking metformin to prevent diabetes in patients with prediabetes over a treatment interval of 10 years should reduce costs to the healthcare system by as much as $422, depending on the cost of metformin compared with placebo, they add.
Lifestyle Intervention
According to the 2012 DPP/DPPOS report, lifestyle intervention would cost $1716 more over 10 years than the cost of taking metformin. “This difference was approximated or increased in the present analysis,” researchers observed: from $1695 if the cost of metformin and vitamin B12 were just $72, to $1850 if the cost of metformin plus vitamin B12 were $40, and to $2045 if patients paid nothing for metformin plus vitamin B12.
“Similarly, in the 2012 DPP/DPPOS report, group lifestyle intervention over 10 years cost $139 more compared with the metformin group, which was approximated or increased in the present analysis,” study authors add. The main disadvantage with any lifestyle intervention to prevent diabetes is that patients have to commit to a multicomponent intervention requiring they eliminate between 500 to 750 calories a day from their diet; increase their level of physical activity to at least 150 minutes a week, and follow a structured behavior-change program.
They also have to agree to attend at least 14 follow-up visits over a period of 6 months, as investigators observe. “Metformin is generally more cost-saving for diabetes prevention than previously reported because of decreasing costs for patients to acquire metformin,” study authors conclude.
“Metformin’s cost savings should be considered when assessing the cost-effectiveness of implementing diabetes prevention programs,” they add.
The authors had no relevant financial relationships.
J Am Pharm Assoc. Published online June 5, 2017. Abstract
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