Estimating the excess expenditures associated with glucagon-like peptide-1 receptor agonist use among adults with diabetes in the United States

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: = 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.