Introduction and Objective: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) prescription increased rapidly in Medicare for type 2 diabetes (T2D), with limited evidence on medical expenditures. We estimated expenditure changes using a matched controlled design.Methods: Using 2015-2023 Medicare fee-for-service claims, we identified beneficiaries aged ≥67 years with prevalent T2D, continuous Part A, B, and D enrollment, and alive during the study period. New users were beneficiaries initiating a GLP-1 RA in 2018 with no use in prior 3 years; users remained in the treatment group regardless of discontinuation. Each user was matched 1:3 to non-users via propensity scores based on baseline age, sex, race/ethnicity, comorbidities, glucose-lowering medication, and pre-period healthcare expenditures and utilization. Non-users were assigned a pseudo-index month drawn from the distribution of initiation months among users to ensure aligned follow-up windows. Quarterly total, prescription, non-prescription medical, and CVD/CKD-related expenditures (in 2023 USD) were measured for 12 quarters before and 20 quarters after index. Difference-in-differences models with individual fixed effects estimated spending changes attributable to initiation.Results: Medical expenditure increased for both groups with time. Among 32,494 beneficiaries, GLP-1 RA initiation was associated with a $1,279 average increase in total quarterly expenditures relative to controls, driven by $1,260 higher quarterly prescription spending. Non-prescription medical costs rose slightly ($19/quarter), and CVD/CKD-related expenditures declined modestly (-$15/quarter).Conclusion: GLP-1 RA initiation increased Medicare spending, primarily through higher prescription costs. Although CVD/CKD savings were statistically detectable, they were small relative to the increase in drug spending. As a result, the net economic impact of GLP-1 RA use may be substantial for healthcare payers.
Y.N. Wang: None. Y. Shao: None. K. Bullard: None. R. Li: None. C.S. Holliday: None. O. Idubor: None. P. Zhang: None.
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