Highlights
- •Single pill drug combinations can improve adherence & reduce pill burden.
- •A 1.4-fold increase in prescriptions of metformin-based combinations (2015–2020).
- •Metformin–sitagliptin & metformin–pioglitazone were the most & least prescribed drugs.
- •Metformin-SGLT2 inhibitors had seen a significant rise in their prescriptions.
Abstract
Aims
There has been an increase in prescribing and costs of oral hypoglycaemic agents in
England and other countries. This study aims to investigate the trends in prescriptions,
costs, and adverse events of metformin and metformin-based single pill drug combinations
from 2015 to 2020 and explore why changes in use or cost are occurring.
Methods
Prescriptions and costs data from Prescription Cost Analysis database and Interactive
Drug Analysis Profiles presenting all suspected ADRs reported for each drug were examined.
Pharmacy level prices were also obtained. Linear regression analysis was used to investigate
the trends in prescribing and costs.
Results
Prescribing and costs of metformin-based single pill drug combinations (as a percent
mean change per year) saw an increase of 8.78% (95% Cl: 7.45%, 10.11%, p = 0.001)
and 5.17% (95% Cl: 2.13%, 8.22%, p = 0.009) on average each year, respectively. Metformin
was the most prescribed monotherapy drug between 2015 and 2020. The cost of prescribing
metformin (as a proportion of total oral hypoglycaemic agents) has been reduced from
30% in 2015 to 17% in 2020. Metformin-dipeptidyl peptidase-4 inhibitor (e.g., metformin–sitagliptin)
combination was the most popular metformin-based single pill drug combination. The
number of adverse drug reactions per million items dispensed shows that metformin
has the lowest adverse drug reactions per million items compared to other oral hypoglycaemic
drugs.
Conclusions
Overall, an increase in prescription items can be seen for metformin-based single
pill drug combinations along with an increase in their costs in primary care in England
between 2015 and 2020. There was a declining trend for the number of ADRs reported
per million prescription items dispensed for metformin-containing single pill combinations,
even though their prescription rate increased.
Abbreviations:
ADR (adverse drug reactions), DPP4 (dipeptidyl-peptidase 4), MHRA (Medicines and Healthcare Product Regulatory Agency), NHS (National Health Service), NICE (National Institute for Health and Care Excellence), PCA (Prescription Cost Analysis), SGLT2 (sodium–glucose co-transporter-2), UK (United Kingdom)Keywords
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Article info
Publication history
Published online: January 31, 2022
Accepted:
January 23,
2022
Received in revised form:
January 17,
2022
Received:
November 8,
2021
Identification
Copyright
© 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
