Abstract
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) effectively reduce hypoglycemia and offer additional clinical benefits such as weight loss. However, their high costs impose a significant economic burden on both patients and payers. Health care expenditures associated with GLP-1 RA use have not been adequately examined in previous studies. OBJECTIVE: To examine the excess expenditures (total, payer, and out-of-pocket) associated with GLP-1 RA use compared with nonuse among adults with diabetes in the United States. METHODS: The study design was cross-sectional using data on adults (aged ≥18 years) with diabetes from multiple years (2016, 2018, and 2020) of the Medical Expenditure Panel Survey. Any GLP-1 RA use was derived from prescription medication files. Dependent variables included total, payer, and out-of-pocket health care expenditures. Excess expenditures associated with GLP-1 RAs were estimated using a multivariable generalized linear model (GLM) with gamma distribution and log link. The model adjusted for age, sex, race and ethnicity, social determinants of health, obesity, physical activity, and comorbid conditions. RESULTS: The study sample consisted of 7,670 adults with diabetes, representing approximately 28.6 million individuals in the United States. Overall, 7.5% of adults with diabetes used GLP-1 RAs, with rates increasing from 4.3% in 2016 to 10.6% in 2020. GLP-1 RA users had higher total ($22,029 vs $15,165, P < 0.001), payer ($20,023 vs $13,758, P < 0.001), and out-of-pocket ($2,006 vs $1,407, P < 0.001) expenditures compared with nonusers. Multivariable GLMs indicated that GLP-1 RA users incurred an adjusted excess of $5,417 (P < 0.001), $4,764 (P < 0.001), and $436 (P = 0.001) for total, payer, and out-of-pocket expenditures, respectively. CONCLUSIONS: One in 13 adults used GLP-1 RAs. GLP-1 RA users had greater overall, third-party, and out-of-pocket expenditures. These findings underscore the growing economic impact of GLP-1 RA use and highlight the importance of developing strategies that balance the proven clinical advantages of GLP-1 RAs against their financial burden.