Published: 2017-01-05

A drug utilization and pharmacoeconomic study of anti-diabetic drugs prescribed to type 2 diabetes mellitus patients visiting the medicine out-patient department of a tertiary care hospital of north India

Amandeep Singh, Shakti Bala Dutta, Amit Varma, Mirza Atif Beg, Hitender Kumar, Amanjot Kaur


Background: Type 2 diabetes mellitus (T2DM) patients require anti-diabetic drugs on chronic basis, frequent monitoring of blood glucose levels and a number of laboratory investigations, all of which result in significant economic burden on the diabetes patients and the world economies. The purpose of this study was to analyse the prescribing pattern to highlight the current approaches to the rational use of anti-diabetic drugs in T2DM patients visiting the medicine out-patient department, and to calculate the economic burden of different anti-diabetic therapies prescribed to patients with T2DM in a tertiary care hospital of north India.

Methods: This prospective study included T2DM patients visiting the out-patient department of medicine of a tertiary care hospital of Uttarakhand, India. Prescriptions of patients diagnosed as cases of T2DM were analysed as per the WHO drug use indicators. For pharmacoeconomic evaluation, the cost variation of different anti-diabetic therapies was compared using the cost-effectiveness analysis method.

Results: 273 prescriptions from 148 men and 125 women were analysed. 805 drugs were prescribed to the patients with an average of 2.95 per encounter: 494 anti-diabetic drugs with an average of 1.81 drugs per patient, and 311 for co-morbid conditions. Of the 494 anti-diabetic drugs, 75.1% were oral anti-diabetic (OAD) agents and 24.9% were insulin’s. Metformin (209) and insulin aspart (42) were the most prescribed OAD and insulin, respectively. The pharmacoeconomic analysis included 138 patients. The cost per unit (1 mg/dl) reduction in fasting blood glucose was lowest with glipizide and metformin combination (INR 10.46) and highest with insulin degludec and insulin aspart combination (INR 217.38). The average total direct cost of therapy for two months was INR 2244.39 ± 2745.05 (INR 362.88 to INR 10806). 86.63% of the average total direct cost of therapy was attributed to anti-diabetic agents.

Conclusions: Metformin was the most common OAD agent and insulin aspart was the most common injectable anti-diabetic drug prescribed in patients with T2DM. The newer anti-diabetic drugs sitagliptin and newer insulin analogues were also prescribed to a great extent. Overall, the prescribing trend was rational to a great extent and had improved since the earlier study in the same institute. The most cost-effective anti-diabetic therapy was combination therapy of glipizide and metformin. The cost of diabetes management is high, especially for insulin therapy.


Diabetes mellitus, Anti-diabetic drugs, Drug utilization, Pharmacoeconomic, Cost effectiveness analysis

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World Health Organization. Diabetes fact sheet N 312. Available at http:// /mediacentre/factsheets/fs312/en/index.html. Accessed on 15 May 2016.

Powers AC. Diabetes mellitus. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill;2008:2275-2279.

World health organization. What is drug utilization research and why is it needed? In: Introduction to drug utilization research. Chapter 1. Geneva: World Health Organization; 2003:8-12.

Einarson TR, Bergman U, Wiholm BE. Principles and practice of pharmacoepidemiology. In: Speight TM, Holford NMG, eds. Avery’s drug treatment. 4th ed. Auckland: Adis international;1996:371-92.

Hogan P, Dall T, Nikolov P. Economic costs of diabetes in the US in 2002. Diabetes Care. 2003;26:917-32.

Haycox A, Boland A, Walley T. Basics of economics, health economics and pharmacoeconomics. In: Walley T, Haycox A, Boland A, eds. Pharmacoeconomics. Edinburgh: Churchill Livingstone;2004:1-16.

Townsend RH. Post marketing drug research and development. Drug Intell Clin Pharm. 1987;21:134-6.

Trask LS. Pharmacoeconomics: principles, methods, and applications. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L, eds. Pharmacotherapy: a pathophysiologic approach. 8th ed. New York:McGraw-Hill Global Education Holdings;2011. Available at: Accessed 26 April 2016.

Scaria S, Raju R, Joseph S, Mohan A, Nair AA. Pharmacoeconomics: principles, methods and indian scenario. Int J Pharm Sci Rev Res. 2015;34(1):37-46.

World health organization. How to investigate drug use in health facilities: Selected drug use indicators. Geneva: WHO/DAP 1993;1:1-87.

WHO Model List of Essential Medicines. Available at http: // /medicines /publications/essentialmedicines/en/index.html. Accessed on 9 March 2016.

National List of Essential Medicines of India, 2015. Available at http: // /WriteReadData/NLEM-2015/NLEM, %202015.pdf. Accessed on 9 March 2016.

Mishra L (ed). Drug today: Ready reckoner of current medical formulations. Lorina Publications (India) Inc. New Delhi.Oct-Dec 2015.

Current index of medical specialities. UBM Medica India Private Limited. 2016;132:479-87.

Agarwal AA, Jadhav PR, Deshmukh YA. Prescribing pattern and efficacy of anti-diabetic drugs in maintaining optimal glycemic levels in diabetic patients. J Basic Clin Pharma. 2014;5:79-83.

Acharya KG, Shah KN, Solanki ND, Rana DA. Evaluation of antidiabetic prescriptions, cost and adherence to treatment guidelines: a prospective, cross-sectional study at a tertiary care teaching hospital. J Basic Clin Pharma. 2013;4:82-7.

Shahir AQ, Kauser S, Gupta D, Ahmed AN. Prescribing patterns of anti-diabetic medications in a tertiary care teaching hospital, Barilley, UP. India J Pharm Sci Innov. 2013;2(1):41-6.

Dashputra AV, Badwaik RT, Borkar AS, Date AP, Kalnawat NR. Pattern of antidiabetic drugs used in outpatient and hospitalized patients in a tertiary health institute of central India. J Cont Med A Dent. 2014;2(3):48-54.

Kannan, Arshad, Kumar S. A study on drug utilization of oral hypoglycemic agents in type-2 diabetic patients. Asian J Pharm Clin Res. 2011;4(4):60-4.

Dutta S, Beg MA, Anjoom M, Varma A, Bawa S. Study of prescribing pattern in diabetes mellitus patients in a tertiary care teaching hospital at Dehradun, Uttarakhand. Int J Med Sci Public Health. 2014;3:1351-4.

Isah AO, Ross-Degnan D, Quick J, Laing R, Mabadeje AFB. The development of standard values for the WHO drug use prescribing indicators. ICUM/EDM/WHO.Available at http:// /prduc2004 /rducd /ICIUM_Posters /1a2_txt.htm. Accessed on 12 May 2016.

Sutharson L, Hariharan RS, Vamsadhara C. Drug utilization study in diabetology outpatient setting of a tertiary hospital. Indian J Pharmacol. 2003;35:237-40.

Sharma P, Sharma N, Parakh R, Sharma N, Gautam B, Motiwale S. Screening of prescriptions in patients of type-2 diabetes mellitus in a tertiary care teaching hospital. Int J Pharmaceutical Res Bio-Sci. 2014;3(1):401-9.

Kumar R, Kohli K, Kajal HL. A study of drug prescribing pattern and cost analysis among diabetic patients in a tertiary care teaching institute in north India. J Drug Delivery Therap. 2013;3(2):56-61.

Alex SM, Sreelekshmi BS, Smitha S, Jiji KN, Menon AS, Devi UP. Drug utilization pattern of anti-diabetic drugs among diabetic outpatients in a tertiary care hospital. Asian J Pharm Clin Res. 2015;8(2):144-6.

George N, Kumar PVA, Amma VS. Glycemic control and cost effectiveness attained by the drug utilization of oral antidiabetic agents in a tertiary care hospital in South India. Int J Basic Clin Pharmacol. 2016;5:684-91.

Inzucchi SE, Bergenstal RM, Buse JB. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. position statement of the American diabetes association (ADA) and the European association for the study of diabetes (EASD). Diabetologia. 2012;55:1577-96.

Approaches to glycemic treatment. American Diabetes Association. Diab Care. 2016;39(1):52-9.

Bennett WL, Wilson LM, Bolen S, Maruthur N, Singh S, Chatterjee R, et al. Oral diabetes medications for adults with type 2 diabetes: an update. comparative effectiveness review. (Prepared by Johns Hopkins evidence-based practice center under contract no. 290-02-0018.) AHRQ publication no. agency for healthcare research and quality. March 2011

Arechavaleta R, Seck T, Chen Y, Krobot KJ, Neill EA, Duran L, et al. Efficacy and safety of treatment with sitagliptin or glimepiride in patients with type 2 diabetes inadequately controlled on metformin monotherapy: a randomized, double-blind, non-inferiority trial. Diabetes Obes Metab. 2011;13(2):160-8.

Okonta JM, Nduka SO, Idodo VE. Prescribing pattern of antihypertensive and antidiabetic agents in a secondary healthcare institution in Nigeria. J Pharm Sci Res. 2013;5(1):12-7.

Bell DS. Combine and conquer: advantages and disadvantages of fixed-dose combination therapy. Diabetes Obes Metab. 2013;15(4):291-300.

Shankar PR. Compliance and rational use of drugs. Drug Inform Bull. 2004;2:1-2.

Rachael F. An introduction to health economics. Pharm J. 2003;271:679-81.

Abdulganiyu G, Fola T. Cost-effectiveness analysis of anti-diabetic therapy in a university teaching hospital. Int J Pharm Sci Research. 2014;5(3):82-91.

Abdelaziz MSL, Rani SH, Ravindranath S, Shaik R, Kasim M, Salam AA. Pharmacoeconomic evaluation of oral-hypoglycemic agents at hospital in Bangalore. J Pharm Bio Sci. 2015;10(5):46-50.

Grover S, Avasthi A, Bhansali A, Chakrabarti S, Kulhara P. Cost of ambulatory care of diabetes mellitus: a study from north India. Postgrad Med J. 2005;81:391-5.

Drugs prices control order. 2013. Available at Accessed on 13 May 2016.

Srinivasan S, Srikrishna T, Aisola M. Pharma price control policy: unrealistic and unfair. economic and political weekly. 2014;49(34):13-5.

Roy V, Rewari S. Ambiguous drug pricing: a physician’s dilemma. Indian J Pharmacol. 1998;30:404-7.

Sarkar PK. A rational drug policy. Indian J Med Ethics. 2004;12:30-5.

Voluntary organisation in interest of consumer education (VOICE). a study on availability and prices of medicines in India. 2002. Available at Accessed on 13 May 2016.