(C-068) Expenditure and Utilization on GLP-1 Medications across High-Income Countries: A repeated cross-sectional analysis

Background: Diabetes is one of the largest causes of morbidity and mortality worldwide, with over 500 million adults affected globally in 2021. Anti-diabetic drugs are among the top expenditure across multiple countries largely due to the increased popularity of new drugs such as glucagon-like peptide-1 (GLP-1) receptor agonists (ex. semaglutide), owing their popularity to their weight-loss benefits.

Objectives: Given country-level differences in coverage and health system structure, we compared expenditure and utilization of diabetes treatments across comparable high-income countries.

Methods: We conducted a repeated cross-sectional study of anti-diabetic drug purchases across Australia, Belgium, Canada, France, Germany, Italy, Japan, Netherlands, New Zealand, Norway, Spain, Sweden, the UK, and the US between the fourth quarter of 2022 and the third quarter of 2023. We used IQVIA’s Multinational Integrated Data Analysis (MIDAS) database to obtain country-level purchasing data for anti-diabetic drugs. We assessed drug expenditure and estimated drug utilization based on sales volume. For each included country, we measured overall anti-diabetic drug purchases in USD and proportion of spending on GLP-1s, adjusting for diabetes prevalence across each country.

Results: Overall, all 14 countries averaged $7.6 million per 10,000 diabetes patients on anti-diabetic medications. This comprised $3.1 million (34.5%) per 10,000 on GLP-1 drugs and $4.5 million (65.5%) per 10,000 on non-GLP-1 spending. GLP-1 drugs comprised 1.1% of total anti-diabetic drug volume. Semaglutide had the highest expenditure across 10 of the 14 included countries. For GLP-1 drug spending as a proportion of overall purchases, Norway ranked first with 56.5%, spending $5.2 million per 10,000 on GLP-1 drugs. This was followed by the US with 47.7% ($17.8 million per 10,000) and Canada with 46.5% ($4.6 million per 10,000). Despite the high proportion of spending on GLP-1s, these medications contributed less than 2% to overall anti-diabetic sales volume.

Conclusions: The growing use of high-cost GLP-1s around the world has driven rising global anti-diabetic drug expenditure. There is variability in GLP-1 use and spending that is likely dependent on country-level differences in how new drugs are covered and made available to patients. This presents a unique opportunity to assess patient access and long-term clinical outcomes, warranting further study in broader healthcare systems as GLP-1 drug use continues to expand.