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Many Physicians Do Not Follow ADA-recommended Prescribing Guidelines

Thirty-five percent of the time for 250,000 newly diagnosed diabetes patients, physicians did not follow the ADA/EASD consensus guidelines for recommended treatment.

In addition to the quality of care implications, because those guidelines recommend use of generic medications rather than more expensive branded medications, patients, payers and the healthcare system could be paying an additional $420 million annually for the newly initiated treatment, the researchers stated.

The study was conducted by researchers from CVS Caremark, Harvard University and Brigham and Women’s Hospital. The review looked at 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 one-third of initial treatment regimens for diabetes did not include the ADA’s recommended first-line drug, which is a generic.

While 65% of the patients studied received care consistent with the ADA consensus statements, the results highlighted remaining gaps between practice recommendations and contemporary pharmacotherapy for type 2 diabetes, researchers wrote in the study.

Senior author, Niteesh K. Choudhry, associate physician in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, associate professor at Harvard Medical School stated that, “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.”

Choudhry added, “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. Because the prevalence of diabetes is increasing quite dramatically, the potential savings from improved adherence to these recommendations could far exceed these estimates.”

The researchers reviewed how doctors are treating newly diagnosed patients through a review of CVS Caremark’s claims data to learn more about the clinical practices for those patients who are prescribed oral medications as part of their treatment. Because there is a substantial price difference between generic and branded medications, the researchers said a look at the economics of treatment was in order. The pharmacy claims they reviewed showed those being treated with generics spent an average of $116.10 over six months, compared with $677.20 for the more expensive therapies. That is a difference of $560 per patient for six months, or $1,120 per patient per year.

American Journal of Medicine, February 23, 2012.